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During winter outbreaks of respiratory syncytial virus bronchiolitis from 2002 to 2004, three infants presented with a presumptive diagnosis of lower respirat ory tract infection and wheezing. The clinical condition in two cases was rapidl y progressive and precipitated into intractable shock; clinical and instrumental examinations revealed a cardiac origin of their illness. A subacute presentatio n permitted a cardiological assessment and a proper treatment in the third infan t. An abnormal origin of the left coronary artery from the pulmonary trunk was d emonstrated in all cases. The concurrent acute airway infection had a catastroph ic effect on the underlying cardiovascular anomaly leading to refractory cardiog enic shock and death. Conclusion:Admission chest X-ray film and arterial gas an alysis can raise the suspicion of cardiac involvement when treating a severe whe ezing episode in young infants. Paediatric cardiological evaluation with two-di mensional echocardiography may eventually reveal this rare condition, whereas ca rdiac catheterisation with aortography remains the standard means of diagnosis.
During winter outbreaks of respiratory syncytial virus bronchiolitis from 2002 to 2004, three infants presented with a presumptive diagnosis of lower respirat ory tract infection and wheezing. The clinical condition in two cases was rapidl y progressive and precipitated into intractable shock; clinical and instrumental examinations revealed a cardiac origin of their illness. A subacute presenta n n a a cardiological assessment and a proper treatment in the third infan t. An abnormal origin of the left coronary artery from the pulmonary trunk was d emonstrated in all cases. The concurrent acute airway infected had a catastroph ic effect on the underlying cardiovascular anomaly leading to refractory cardiog enic shock and death. Conclusion: Admission chest X-ray film and arterial gas an anlysis can raise the suspicion of cardiac involvement when treating a severe whe ezing episode in young infants. cardiological evaluation with two-di mensional echocardiography may eve ntually reveal this rare condition, while ca rdiac catheterisation with aortography remains the standard means of diagnosis.