Coronary Anomaly Preventing Transcatheter Closure of an Atrial Septal Defect

A 4-year-old asymptomatic girl presented for elective transcatheter closure of her ostium secundum atrial septal defect (ASD). Her examination revealed a fixed split second heart sound with a 2/6 systolic ejection murmur at the left upper sternal border and a right ventricular lift. Transthoracic echocardiogram demonstrated a 15-mm secundum ASD with a mildly dilated right ventricle. The left coronary artery (LCA) could not be readily identified on the study. The patient was referred for percutaneous device closure when a preprocedural transesophageal echocardiogram revealed a moderate-sized secundum ASD with left to right shunting, moderate right ventricle dilation, and an anomalous origin of the LCA from the right sinus of Valsalva was identified (Figure 1A). The origin and distribution of the right coronary artery was normal. Cardiac catheterization revealed a Qp:Qs …