We report the case of a 16-year-old adolescent, a previously asymptomatic secondary student, who consulted at the Centro Médico de Clínica Reñaca with a history of angina pectoris of major efforts of several weeks duration.
Physical examination was normal.
A resting electrocardiogram and a chest X-ray were normal.
A stress test under Bruce protocol caused a 2 mm decrease in the ST segment at 9 min in the AVL, II, III, AVp, V4, V5, Vg leads.
A Thallium-201 myocardial scintigraphy showed a reversible posteroinferior septal perfusion defect, suggesting ischemia.
A two-dimensional echocardiogram showed a saccular dilation of 7 mm in the proximal portion of the left coronary artery.
Subsequently, a coronary angiography was performed which demonstrated the existence of severe coronary disease with aneu-rismatic dilatation of the proximal segment of the anterior descending artery and the proximal segment of the right coronary artery, consistent with the angiographic aspect that is observed.
The two vessels were filled through collaterals from the circumflex artery and the first diagonal.
Left ventriculography was normal.
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The patient had no history of dyslipidemia, family history of heart disease or chest trauma.
However, at 5 years of age, she was hospitalized in a Pediatric Intensive Care Unit of the V region due to high fever, bilateral cervical lymphadenopathy and congestive heart failure.
During a prolonged hospitalization, she required therapy with a combination of vasoactive drugs (dopamine, dobutamine, amrinone), as well as mechanical ventilation.
At the time, a diagnosis of «toxic shock syndrome» was proposed.
Other studies with negative results included: serology for syphilis, hepatitis B and C, ANCA, antinuclear antibodies and anticardioli-pines, as well as ultrasound study for peripheral aneurysms.
The patient underwent coronary revascularization surgery with a sequential bridge of the left internal mammary artery to the anterior descending artery and first diagonal, and a bridge of the right internal mammary artery to the posterior descending artery.
During surgery, the angiographic findings previously described were confirmed.
Five years after follow-up, the patient is asymptomatic on aspirin 100 mg daily, and a stress test and myocardial scintigraphy with Talio-201 were normal.
