Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2016; 8(7): 432-435
Published online Jul 26, 2016. doi: 10.4330/wjc.v8.i7.432
Rare presentation of intralobar pulmonary sequestration associated with repeated episodes of ventricular tachycardia
D Sheshagiri Rao, Ramachandra Barik
D Sheshagiri Rao, Ramachandra Barik, Department of Cardiology, Nizam’s Institute of Medical Sciences, Hyderabad 500082, Telangana, India
Author contributions: Rao DS had suggested the line of management; Barik R had done the procedure and written the manuscript.
Institutional review board statement: This case report was won the approval of the institutional ethical committee and the Review Board standards at Nizam’s Institute of Medical Sciences, Hyderabad, India.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ramachandra Barik, Department of Cardiology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad 500082, Telangana, India. cardioramachandra@gmail.com
Telephone: +91-040-23404156Fax: +91-040-23310076
Received: March 6, 2016
Peer-review started: March 7, 2016
First decision: April 15, 2016
Revised: May 5, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: July 26, 2016
Abstract

Arterial supply of an intralobar pulmonary sequestration (IPS) from the coronary circulation is extremely rare. A significant coronary steal does not occur because of dual or triple sources of blood supply to sequestrated lung tissue. We present a 60-year-old woman who presented to us with repeated episodes of monomorphic ventricular tachycardia (VT) in last 3 mo. Radio frequency ablation was ineffective. On evaluation, she had right lower lobe IPS with dual arterial blood supply, i.e., right pulmonary artery and the systemic arterial supply from the right coronary artery (RCA). Stress myocardial perfusion scan revealed significant inducible ischemia in the RCA territory. Coronary angiogram revealed critical stenosis of proximal RCA just after the origin of the systemic artery supplying IPS. The critical stenosis in the RCA was stented. At 12 mo follow-up, she had no further episodes of VT or angina.

Keywords: Coronary steal, Coronary artery disease, Ventricular tachycardia, Angioplasty, Intralobar pulmonary sequestration

Core tip: The intralobar pulmonary sequestration (IPS) of right lower lobe of the lung (RLL) is less than 10% of all the pulmonary sequestration. It is rare to encounter that right coronary artery is being the source of systemic arterial supply to IPS of RLL. This anomalous artery was the reason for ischemia in the area subtended by right coronary artery (RCA) by coronary steal phenomenon. A significant stenosis of RCA just distal to origin of the anomalous artery supplying the IPS is extremely rare which was further worsening ischemia by incremental steal. We felt excessive stealing from RCA was the reason for ischemic ventricular tachycardia in this patient. Angioplasty of right coronary stenosis relieved ischemia in the area subtended by RCA by removing obstruction and reducing coronary steal.