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Lv L, Lang X, Zhang S, Wang C, Jin Y, Zhi A, Wang Q. Effectiveness and Safety of Mitral Valve Plasty in Patients with an Anomalous Origin of the Coronary Artery from the Pulmonary Artery. J Cardiovasc Dev Dis 2023; 10:jcdd10020075. [PMID: 36826571 PMCID: PMC9959487 DOI: 10.3390/jcdd10020075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
The study aimed to determine the effectiveness and safety of anomalous coronary artery from pulmonary artery (ACAPA) patients with moderate or severe mitral valve regurgitation (MVR) receiving mitral valve plasty (MVP) concurrently. Consecutive ACAPA patients undergoing surgery between 2015 and 2021 were retrospectively included. Patients were divided into three groups: moderate MVR without MVP (non-MVP (moderate) N = 14), moderate MVR with MVP (MVP (moderate) N = 13), and severe MVR with MVP (MVP (severe) N = 13). The primary safety endpoint was in-hospital surgery-related complications. The primary effectiveness outcome was left ventricular ejection function (LVEF) and left ventricular end-diastolic diameter (LVEDD) z-score at 2- and 24-month follow-ups. Multivariable linear regression models were used to obtain the β coefficient. The median age of the included patients was 7.5 years (IQR 1.4-26.5). The in-hospital surgery-related complication rates were 7.1%, 15.4%, and 7.7% in non-MVP (moderate), MVP (moderate), and MVP (severe) groups, separately. At the 2-month follow-up, the non-MVP (moderate) group had a better LVEF and LVEDD z-score compared with the MVP (moderate) group (LVEF β = 9.22, 95%CI 1.09 to 17.35; LVEDD z-score β = -2.49, 95%CI -4.53 to -0.45). At the 24-month follow-up, the LVEF of all patients and the LVEDD z-score of 90% of patients in the three groups returned to normal. For ACAPA patients with moderate MVR, MVP was not necessary, especially for pediatric patients (age < 3 years) and patients with secondary MVR. Further studies for ACAPA patients with severe MVR are still needed.
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Affiliation(s)
- Lizhi Lv
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming 650102, China
| | - Xinyue Lang
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, The National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 102308, China
| | - Simeng Zhang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Cardiac Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Cheng Wang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming 650102, China
| | - Yuanhao Jin
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Aihua Zhi
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Radiology, Yunnan Fuwai Cardiovascular Hospital, Kunming 650102, China
- Correspondence: (A.Z.); (Q.W.)
| | - Qiang Wang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming 650102, China
- Correspondence: (A.Z.); (Q.W.)
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Yu J, Ren Q, Liu X, Chen T, Liufu R, Wen S, Chen J, Cen J, Zhuang J. Anomalous left coronary artery from the pulmonary artery: Outcomes and management of mitral valve. Front Cardiovasc Med 2022; 9:953420. [PMID: 36277763 PMCID: PMC9584047 DOI: 10.3389/fcvm.2022.953420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Use of concomitant mitral valve repair remains controversial in the anomalous left coronary artery from the pulmonary artery (ALCAPA) with mitral regurgitation (MR). This study aimed to evaluate postoperative mitral valve function and explore the indication for concomitant mitral valve repair. Materials and methods The medical records of 111 patients with ALCAPA and MR who underwent ALCAPA surgery between April 2006 and November 2020 were reviewed. The patients were categorized into three groups for comparison, namely, group I consisted of 38 patients with trivial or mild MR who underwent ALCAPA repair only; group II consisted of 37 patients with moderate or severe MR who similarly had only surgery of the ALCAPA performed; and group III consisted of 36 patients who had concomitant mitral valve repair for moderate or severe MR. Result Overall mortality was 7.2% (8 of 111). The mortality of group II (16.2%, 6 of 37) was higher than those of groups I (5.3%, 2 of 38) and III (0%, 0 of 36) (p = 0.027). All three patients who underwent mitral valve reintervention were in group II. At the last follow-up, none of the patients had more than moderate MR in group I. The percentage of patients with improved MR grade was 79.4% (27 of 34) in group III and 51.4% (19 of 37) in group II (p = 0.001). The multivariate logistic regression revealed that concomitant mitral valve repair (adjusted odds ratio = 4.492, 95% CI: 1.909–12.794; p < 0.001) was the major factor influencing MR grade improvement. Conclusion The long-term outcomes after ALCAPA repair were favorable. For mild MR, ALCAPA repair only can be performed. For moderate and severe MR, we suggest concomitant mitral valve repair.
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Affiliation(s)
- Juemin Yu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,School of Medicine, South China University of Technology, Guangzhou, China
| | - Qiushi Ren
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaobing Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tianyu Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rong Liufu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianzheng Cen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,*Correspondence: Jian Zhuang,
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Total anomalous origin of the coronary arteries from the right pulmonary artery. Indian J Thorac Cardiovasc Surg 2022; 38:231-234. [PMID: 35221566 PMCID: PMC8857382 DOI: 10.1007/s12055-021-01274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/01/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022] Open
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Cashen K, Kwiatkowski DM, Riley CM, Buckley J, Sassalos P, Gowda KN, Iliopoulos I, Bakar A, Chiwane S, Badheka A, Moser EAS, Mastropietro CW. Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery: A Retrospective Multicenter Study. Pediatr Crit Care Med 2021; 22:e626-e635. [PMID: 34432672 DOI: 10.1097/pcc.0000000000002820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to describe characteristics and operative outcomes from a multicenter cohort of infants who underwent repair of anomalous left coronary artery from the pulmonary artery. We also aimed to identify factors associated with major adverse cardiovascular events following anomalous left coronary artery from the pulmonary artery repair. DESIGN Retrospective chart review. SETTING Twenty-one tertiary-care referral centers. PATIENTS Infants less than 365 days old who underwent anomalous left coronary artery from the pulmonary artery repair. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Major adverse cardiovascular events were defined as the occurrence of postoperative extracorporeal membrane oxygenation, cardiopulmonary resuscitation, left ventricular assist device, heart transplantation, or operative mortality. Factors independently associated with major adverse cardiovascular events were identified using multivariable logistic regression analysis. We reviewed 177 infants (< 365 d old) who underwent anomalous left coronary artery from the pulmonary artery repair between January 2009 and March 2018. Major adverse cardiovascular events occurred in 36 patients (20%). Twenty-nine patients (16%) received extracorporeal membrane oxygenation, 14 (8%) received cardiopulmonary resuscitation, four (2%) underwent left ventricular assist device placement, two (1%) underwent heart transplantation, and six (3.4%) suffered operative mortality. In multivariable analysis, preoperative inotropic support (odds ratio, 3.5; 95% CI, 1.4-8.5), cardiopulmonary bypass duration greater than 150 minutes (odds ratio, 6.9 min; 95% CI, 2.9-16.7 min), and preoperative creatinine greater than 0.3 mg/dL (odds ratio, 2.4 mg/dL; 95% CI, 1.1-5.6 mg/dL) were independently associated with major adverse cardiovascular events. In patients with preoperative left ventricular end-diastolic diameter measurements available (n = 116), left ventricular end-diastolic diameter z score greater than 6 was also independently associated with major adverse cardiovascular events (odds ratio, 7.6; 95% CI, 2.0-28.6). CONCLUSIONS In this contemporary multicenter analysis, one in five children who underwent surgical repair of anomalous left coronary artery from the pulmonary artery experienced major adverse cardiovascular events. Preoperative characteristics such as inotropic support, creatinine, and left ventricular end-diastolic diameter z score should be considered when planning for potential postoperative complications.
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Affiliation(s)
- Katherine Cashen
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - David M Kwiatkowski
- Department of Pediatrics, Pediatric Heart Center Lucille Packard Children's Hospital, Palo Alto, CA
| | - Christine M Riley
- Department of Pediatrics, Children's National Health System, Washington, DC
| | - Jason Buckley
- Department of Pediatrics, Medical University of South Carolina Children's Hospital, Charleston, SC
| | - Peter Sassalos
- Department of Cardiac Surgery, University of Michigan, CS Mott Children's Hospital, Ann Arbor, MI
| | | | - Ilias Iliopoulos
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Adnan Bakar
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center of New York, New Hyde Park, NY
| | - Saurabh Chiwane
- Department of Pediatrics, Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Aditya Badheka
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Elizabeth A S Moser
- Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Christopher W Mastropietro
- Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
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Hu R, Zhang W, Yu X, Zhu H, Zhang H, Liu J. Midterm Surgical Outcomes for ALCAPA Repair in Infants and Children. Thorac Cardiovasc Surg 2021; 70:2-9. [PMID: 33851407 DOI: 10.1055/s-0041-1725978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical correction of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) has been associated with excellent survival during recent years. The purpose of this study was to evaluate the effectiveness of reimplantation of the coronary artery and to investigate the recovery of postoperative cardiac and mitral valve (MV) function. METHODS From 2005 to 2015, 80 patients who had ALCAPA received surgical correction. Among them, 49 were infants. The median patient age was 7.8 months. Operative strategies included reimplantation of the coronary artery in 71 patients, the Takeuchi procedure in another 7 patients, and coronary artery ligation in the remaining 2 patients. RESULTS There were 11 hospital deaths and 2 late deaths. Six patients required intraoperative or postoperative mechanical circulatory support. A significant improvement in the ejection fraction (EF) and shortening fraction (SF) was present in all surviving patients at discharge, at a 3-month follow-up and at a 1-year follow-up. MV function improved gradually after surgical repair with no late secondary intervention. CONCLUSIONS The repair of ALCAPA can be accomplished by establishment of a dual-coronary system, which offers an acceptable mortality rate and will rarely require a second surgery. Left ventricular (LV) recovery is a progressive process, especially for infants with impaired LV function. Concomitant MV annuloplasty is safe and reliable and can be performed as necessary in patients with moderate or severe mitral valve regurgitation.
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Affiliation(s)
- Renjie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Wen Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Xiafeng Yu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Hongbin Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Jinfen Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Triglia LT, Guariento A, Zanotto L, Zanotto L, Cattapan C, Hu R, Zhang H, Herbst C, Hörer J, Sarris G, Ebels T, Maruszewski B, Tobota Z, Blitzer D, Lorenzoni G, Bottigliengo D, Gregori D, Padalino M, Di Salvo G, Vida VL. Anomalous left coronary artery from pulmonary artery repair: Outcomes from the European Congenital Heart Surgeons Association Database. J Card Surg 2021; 36:1910-1916. [PMID: 33651393 DOI: 10.1111/jocs.15448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/07/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We sought to determine the surgical outcomes of patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) enrolled in the European Congenital Heart Surgeons Association (ECHSA) database. MATERIALS AND METHODS From 1999 to 2019, 907 patients with ALCAPA underwent surgical repair and were included in the current study. The primary outcome was in-hospital mortality. Secondary outcomes included frequency and results of concomitant mitral valve surgery and postoperative mechanical circulatory support (MCS). RESULTS The overall in-hospital mortality was 6% (54/907) and was significantly higher in neonates (p = .01), patients with lower body surface area (BSA) (p = .01), and those requiring postoperative MCS (p = .001). Associated mitral valve surgery was performed in 144 patients (15.9%) and was associated with longer cardiopulmonary bypass (CPB) and aortic cross-clamp times (AOX) (p ≤ .0001) but was not significantly related to an increase in in-hospital mortality. Postoperative MCS was required in 66 patients (7.3%). These patients were younger (p ≤ .001), had a lower BSA (p ≤ .001), and required a longer CPB (p ≤ .001) and AOX time (p ≤ .001). CONCLUSIONS ALCAPA repair can be achieved successfully, and with low surgical risk. Concomitant mitral valve procedures can be performed without increasing operative mortality. The use of MCS remains a valuable option, especially in younger patients.
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Affiliation(s)
- Laura Torlai Triglia
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Claudia Cattapan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Renjie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Claudia Herbst
- Department of Surgery, Division of Cardiac Surgery and Pediatric Heart Center, Medical University Vienna, Vienna, Austria
| | - Jurgen Hörer
- Division for Congenital and Pediatric Heart Surgery, University Hospital of Munich (LUM), Munich, Germany
| | - George Sarris
- Department of Pediatric and Congenital Cardiac Surgery, Athens Heart Surgery Institute, IASO Children's Hospital, Athens, Greece
| | - Tjark Ebels
- Departments of Congenital Cardiothoracic Surgery Thoraxcentrum, University Medical Center Groningen, Groningen, Netherlands
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
| | - Zdzislaw Tobota
- Department for Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
| | - David Blitzer
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | | | | | - Dario Gregori
- Biostatistic Unit, University of Padua, Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giovanni Di Salvo
- Department of Children and Woman's Health, Pediatric Cardiology Unit, University of Padua, Padua, Italy
| | - Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Biçer M, Korun O, Yurdakök O, Çiçek M, Dedemoğlu M, Özdemir F, Kılıç Y, Altın HF, Şaşmazel A, Aydemir NA. Anomalous left coronary artery from the pulmonary artery repair outcomes: Preoperative mitral regurgitation persists in the follow-up. J Card Surg 2020; 36:530-535. [PMID: 33331064 DOI: 10.1111/jocs.15247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aims to present the midterm outcomes of surgical correction of the anomalous left coronary artery from the pulmonary artery (ALCAPA) with a focus on mitral regurgitation (MR). METHODS Medical records of 36 ALCAPA patients who underwent surgery in a single center were retrospectively reviewed. RESULTS There were one (2.7%) neonate, 19 (52.7%) infants, 15 (41.6%) children, and 1 (2.7%) adult patient operated. Coronary reimplantation, tube reconstruction, and coronary artery bypass surgery techniques were performed in 29 (80.5%), 6 (16.6%), and 1 (2.7%) patient, respectively. Sixteen (44.4%) patients had a low ejection fraction and 13 (36.1%) patients had at least moderate MR preoperatively. None of our patients underwent a concomitant mitral surgery during the initial repair. Three and two patients died in the early and late postoperative period, respectively. Two patients underwent reoperation due to MR and pulmonary stenosis, separately. Preoperative MR was the only factor associated with at least moderate MR at the final follow-up (p < .01) and the presence of preoperative moderate or over-moderate MR estimated at least moderate MR at the final follow-up with 100% sensitivity and 80% specificity. CONCLUSION Although the mitral valve was not repaired in the first operation, the reoperation rate is low. However, a moderate or higher preoperative MR predicted MR at the last follow-up. Performing annuloplasty in such patients can be a strategy to be researched.
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Affiliation(s)
- Mehmet Biçer
- Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.,Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Oktay Korun
- Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Okan Yurdakök
- Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Çiçek
- Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Dedemoğlu
- Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.,Pediatric Cardiovascular Surgery Department, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatih Özdemir
- Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.,Pediatric Cardiovascular Surgery Department, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yiğit Kılıç
- Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hüsnü F Altın
- Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Şaşmazel
- Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Numan A Aydemir
- Pediatric Cardiovascular Surgery Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Intermediate Outcomes After Repair of Anomalous Left Coronary Artery From the Pulmonary Artery. Ann Thorac Surg 2020; 112:1307-1315. [PMID: 32961142 DOI: 10.1016/j.athoracsur.2020.06.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multicenter studies on infants with anomalous left coronary artery from the pulmonary artery (ALCAPA) are lacking. We report the intermediate-term outcomes after ALCAPA repair in a multicenter cohort and identify risk factors for reintervention or death after discharge. METHODS We retrospectively reviewed infants under 1 year of age who underwent ALCAPA repair from January 2009 to March 2018 at 21 US centers. The primary composite outcome was freedom from reintervention or death after discharge. We used the Kaplan-Meier survival analysis to examine freedom from reintervention or death and the Cox proportional hazard analysis to identify risk factors for this composite outcome. RESULTS One hundred seventy-seven infants underwent ALCAPA repair; 170 (97%) survived to hospital discharge without transplantation. Twenty-three patients were lost to follow-up. The median duration of follow-up in the remaining 147 patients was 3.8 years (25%, 75%: 1.9 years, 6.0 years). Echocardiographic data were available at ∼3 years after discharge in 98 patients. Left ventricular function was normal in 96 patients (98%), whereas 26 patients (27%) had greater than mild mitral valve regurgitation. Sixteen patients (11%) underwent 20 reinterventions with 1 late death. Patients undergoing the Takeuchi procedure or atypical repairs (hazard ratio, 8.0; 95% confidence interval, 2.1-30.0) or with moderate or greater mitral regurgitation on discharge echocardiogram (hazard ratio, 3.4; 95% confidence interval, 1.2-9.1) were at increased risk for reintervention. CONCLUSIONS Intermediate-term outcomes after ALCAPA repair in infants are favorable. Persistent left ventricular dysfunction and reinterventions were uncommon, and mortality was rare. Patients who required atypical surgical repair or had moderate or greater mitral regurgitation at discharge warrant closer follow-up.
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Kwiatkowski DM, Mastropietro CW, Cashen K, Chiwane S, Flores S, Iliopoulos I, Karki KB, Migally K, Radman MR, Riley CM, Sassalos P, Smerling J, Costello JM. Characteristics and Surgical Outcomes of Patients With Late Presentation of Anomalous Left Coronary Artery From the Pulmonary Artery: A Multicenter Study. Semin Thorac Cardiovasc Surg 2020; 33:141-150. [PMID: 32858217 DOI: 10.1053/j.semtcvs.2020.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/20/2020] [Indexed: 11/11/2022]
Abstract
We sought to describe the clinical course and outcomes of patients who are diagnosed with anomalous left coronary artery from the pulmonary artery (ALCAPA) after infancy. We conducted a retrospective evaluation of patients who underwent ALCAPA surgery between January 2009 to March 2018 at 21 US centers. Clinical presentation, inpatient management, and postoperative outcomes of patients repaired ≥1 year of age were described. To characterize this cohort, we compared these data to patients repaired before 1 year of age. Of 248 ALCAPA patients, 71 (29%) underwent repair ≥1 year of age. Among this subset, the median age at diagnosis was 8.3 years. Chronic arrhythmia occurred in 7%. Patients had good postoperative recovery of left ventricle (LV) dysfunction (90%) and LV dilation (75%), although a low incidence of recovery of mitral regurgitation (40%). Compared to infants, older patients were more likely to present with cardiac arrest (11% vs 1%) and less likely to have moderate or worse LV dysfunction or mitral regurgitation. Older patients had significantly less postoperative extracorporeal membrane oxygenation use, and shorter ICU and hospital stay. In the older cohort, operative mortality occurred in only 1 patient and no patient died after discharge (median follow-up 2.7 years). Survival of patients who presented with ALCAPA beyond infancy was excellent, although chronic mitral regurgitation and chronic arrhythmia were not uncommon. Patients who underwent ALCAPA repair ≥1 year of age were less likely to present with LV dysfunction but more likely to present with cardiac arrest than younger patients.
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Affiliation(s)
- David M Kwiatkowski
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California.
| | - Christopher W Mastropietro
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Katherine Cashen
- Division of Critical Care, Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Saurabh Chiwane
- Division of Pediatric Critical Care, Department of Pediatrics, Saint Louis University, Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Saul Flores
- Sections of Critical Care and Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Ilias Iliopoulos
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Karan B Karki
- Division of Critical Care, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Karl Migally
- Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Monique R Radman
- Division of Critical Care, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Christine M Riley
- Division of Cardiac Critical Care, Children's National Health System, Washington, District of Columbia
| | - Peter Sassalos
- Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Jennifer Smerling
- Department of Pediatrics, Columbia University College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York, New York, New York
| | - John M Costello
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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Surgical outcomes for anomalous left coronary artery from the pulmonary artery: Influence of late presentation. J Thorac Cardiovasc Surg 2019; 159:1945-1952.e1. [PMID: 31767362 DOI: 10.1016/j.jtcvs.2019.09.179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Although surgical outcomes for anomalous left coronary artery from the pulmonary artery (ALCAPA) are excellent in the modern era with the coronary reimplantantion technique, mortality remains high in Chinese population. This study was undertaken to review the surgical management for ALCAPA in our center and assess the midterm outcomes. METHODS This was a retrospective review of 105 patients who underwent surgical repair for ALCAPA from January 2008 to January 2018. RESULTS The diagnosis of ALCAPA was not made before referred to our hospital in 31 patients (30%). Median age at repair was 7.6 months (interquartile range, 4.3-25.4 months). Mean preoperative left ventricular ejection fraction was 47.3% ± 16.9%. Concomitant mitral intervention was performed in 52 patients (50%). Mechanical circulatory support was used in 15 patients (14%). Early mortality was 14%. Classification and regression tree analysis identified 3 risk groups for early mortality, among which patients with preoperative left ventricular ejection fraction ≤41.6% and age at repair >127 days were the most likely to suffer from mortality. Using nonlinear mixed-effect model to assess the time course for postoperative left ventricular ejection fraction, patients of this group also needed significantly longer time for recovery of left ventricular function after surgery (P < .0001). CONCLUSIONS Late referral of patients with ALCAPA is not uncommon in our center. Older age at repair in patients with preoperative left ventricular dysfunction is the main reason for higher early mortality, and is also associated with longer time to normalization of left ventricular function after surgery.
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Zhang C, Luo Q, Li Y, Wu X, Hao Z, Li S, Xia Z, Yan F, Sun L. Predictors of Short-term Outcomes Following Repair of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery in Chinese Children: A Case-Control Study. J Cardiothorac Vasc Anesth 2018; 32:2644-2651. [DOI: 10.1053/j.jvca.2018.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/11/2022]
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12
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Dhar A, Aronowitz D, Misra N, Meyer DB. Surgical Angioplasty of Stenotic Left Main Coronary Artery 15 Years After ALCAPA Repair. Ann Thorac Surg 2017; 104:e269-e270. [PMID: 28838525 DOI: 10.1016/j.athoracsur.2017.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 02/28/2017] [Accepted: 03/14/2017] [Indexed: 11/24/2022]
Abstract
Studies regarding long-term results after repair of anomalous left main coronary artery from the pulmonary artery (ALCAPA) have mainly focused on survival rates, left ventricular function, and mitral valve function. The development of left main coronary stenosis following repair has been infrequently reported and its incidence unknown. Optimal therapy is also not known. Here we report the use of surgical angioplasty to achieve revascularization of a stenotic left main coronary artery in a patient with ALCAPA who had undergone coronary transfer 15 years earlier.
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Affiliation(s)
- Arushi Dhar
- Department of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, New York.
| | | | - Nilanjana Misra
- Department of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - David Benjamin Meyer
- Department of Pediatric Cardiothoracic Surgery, Cohen Children's Medical Center of New York, New Hyde Park, New York
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13
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Qiu J, Li S, Yan J, Wang Q, Song Y, Sun H, Li D. Repair of anomalous coronary artery from the pulmonary artery: A-signal center 20-year experience. Int J Cardiol 2016; 223:625-629. [DOI: 10.1016/j.ijcard.2016.08.221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/11/2016] [Indexed: 11/29/2022]
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V Joshi S, V Naik A, S Bhalgat P, Chavan B, Salvi P. An experience with off pump technique for repair of anomalous left coronary artery from pulmonary artery (ALCAPA). Indian Heart J 2016; 68:704-708. [PMID: 27773411 PMCID: PMC5079130 DOI: 10.1016/j.ihj.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/27/2016] [Accepted: 02/02/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Anomalous origin of left coronary artery from pulmonary artery is a very rare disease with incidence of one every 300,000 live births. It has a high mortality of 80% in the first year of life. This observational study summarized our experience using the technique of subclavian arterial bypass without the use of cardiopulmonary bypass (CPB) for treatment of this coronary anomaly in pediatric population. The study aims to revive an earlier technique, with modifications, as an alternative to the existing coronary translocation. METHODS From 2009 till 2015, six consecutive infants were operated by a single surgeon using subclavian artery to left coronary artery bypass done off pump, to establish a two coronary circulation. RESULTS Five patients had an improvement in their LV ejection fractions at the time of the last follow-up. Angiography done in two cases after 2 and 6 years after surgery revealed good flow in the left coronary artery and good growth in the length of subclavian artery. There was one surgical mortality in this series. CONCLUSIONS The technique of off pump subclavian arterial bypass for anomalous origin of the left coronary artery from the pulmonary artery is a viable alternative to the existing standard technique of coronary translocation. It essentially eliminates extracorporeal circulatory support or a left heart bypass that may be needed after coronary translocation. Also, the advantage of avoiding CPB, both in economic terms and also the adverse effects related to use of bypass in this very sick hearts, cannot be disregarded.
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Affiliation(s)
- Suresh V Joshi
- Department of Pediatric and Congenital Heart Centre, New Age Wockhardt Hospital, Mumbai, India
| | - Abhijeet V Naik
- Department of Pediatric and Congenital Heart Centre, New Age Wockhardt Hospital, Mumbai, India.
| | - Parag S Bhalgat
- Department of Pediatric and Congenital Heart Centre, New Age Wockhardt Hospital, Mumbai, India
| | - Bhushan Chavan
- Department of Pediatric and Congenital Heart Centre, New Age Wockhardt Hospital, Mumbai, India
| | - Prasanna Salvi
- Department of Pediatric and Congenital Heart Centre, New Age Wockhardt Hospital, Mumbai, India
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Karimi M, Kirshbom PM. Anomalous Origins of Coronary Arteries From the Pulmonary Artery: A Comprehensive Review of Literature and Surgical Options. World J Pediatr Congenit Heart Surg 2016; 6:526-40. [PMID: 26467866 DOI: 10.1177/2150135115596584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anomalous origins of coronary arteries from the pulmonary artery are rare malformations in which the coronary arteries originate from pulmonary artery sinuses or branches. The consequences are variable although, in most cases, these anomalies lead to severe coronary hypoperfusion and ventricular dysfunction. Surgical correction is indicated once the diagnosis is established due to high early mortality associated with the disease. In nearly all cases, the anomalous artery can be excised from its pulmonary origin, mobilized, and reimplanted directly into the ascending aorta using different surgical techniques. In rare circumstances, technical modifications must be used to restore a normal dual coronary perfusion. The emphasis of this article is to provide a collective review of surgical options published in the literature.
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Affiliation(s)
- Mohsen Karimi
- Department of Surgery, Section of Cardiac Surgery, Pediatric Cardiothoracic Surgery, Northeast Pediatric Specialties (NEPS), Yale University School of Medicine, New Haven, Connecticut and Connecticut Children's Medical Center, Hartford, CT, USA
| | - Paul M Kirshbom
- Department of Surgery, Section of Cardiac Surgery, Pediatric Cardiothoracic Surgery, Northeast Pediatric Specialties (NEPS), Yale University School of Medicine, New Haven, Connecticut and Connecticut Children's Medical Center, Hartford, CT, USA
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16
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Mongé MC, Eltayeb O, Costello JM, Sarwark AE, Carr MR, Backer CL. Aortic Implantation of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery: Long-Term Outcomes. Ann Thorac Surg 2015; 100:154-60; discussion 160-1. [DOI: 10.1016/j.athoracsur.2015.02.096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
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A rare cause of respiratory distress in the emergency department: anomalous origin of the left coronary artery from the pulmonary artery. Pediatr Emerg Care 2015; 31:357-9. [PMID: 25931341 DOI: 10.1097/pec.0000000000000426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery is the most common cause of myocardial ischemia and infarction in children and infants. Most of the affected individuals become symptomatic, owing to dilated cardiomyopathy during the infant period. Because of congestive heart failure, pulmonary congestion and respiratory distress can be seen. Herein, we report a 35-day-old infant with anomalous origin of the left coronary artery from the pulmonary artery who presented with respiratory distress and dilated cardiomyopathy to draw attention to this rare surgically treatable anomaly.
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Peer SM, Emerson DA, Costello JP, Shu MK, Zurakowski D, Jonas RA, Berger JT, Nath DS. Intermediate-term results of extracorporeal membrane oxygenation support following congenital heart surgery. World J Pediatr Congenit Heart Surg 2015; 5:236-40. [PMID: 24668971 DOI: 10.1177/2150135113515495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although there are considerable data regarding in-hospital results of congenital heart surgery (CHS) patients requiring postoperative extracorporeal membrane oxygenation (ECMO) support, there is limited information on intermediate-term outcomes. METHODS A single-institution retrospective review of 25 consecutive postoperative CHS patients who required ECMO and survived to hospital discharge between January 2003 and June 2008. Survival was estimated by the Kaplan-Meier method. RESULTS At a median follow-up of 3.3 years (interquartile range: 1.2-5.9 years), there was one death which occurred at six months postsurgery. Kaplan-Meier-estimated survival at three years was 95% (95% confidence interval: 90%-100%). Indications for ECMO included extracorporeal cardiopulmonary resuscitation (48%), systemic hypoxia (4%), postoperative low-cardiac output syndrome (28%), and intraoperative failure to wean off cardiopulmonary bypass (20%). Following ECMO support, 65% of patients had unplanned cardiac reinterventions (three requiring operative interventions, six requiring percutaneous interventions, and four requiring both), and 47% of patients required unplanned hospitalizations. In all, 29% of patients developed neurological deficits and 12% of patients developed chronic respiratory failure. No patients developed renal failure. Overall, systemic ventricular (SV) function normalized in 83% of patients, whereas 17% of patients had persistent mild-to-moderate SV dysfunction. CONCLUSIONS Intermediate-term patient survival of ECMO following CHS is encouraging. However, neurological impairment and unplanned cardiac reinterventions remain significant concerns. Further delineation of risk factors to improve patient outcomes is warranted.
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Affiliation(s)
- Syed M Peer
- Division of Cardiovascular Surgery, Children's National Medical Center, Washington, DC, USA
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Anomalous left coronary artery connected to the pulmonary artery associated with other cardiac defects: a difficult joint diagnosis. Pediatr Cardiol 2014; 35:1198-205. [PMID: 24898291 DOI: 10.1007/s00246-014-0916-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 04/25/2014] [Indexed: 10/25/2022]
Abstract
Anomalous left coronary artery connected to the pulmonary artery (ALCAPA) can be associated rarely with other congenital heart defects. The preoperative joint diagnosis is challenging. From 1987 to 2012, a retrospective bicentric assessment of 12 patients with ALCAPA related to other cardiac defects focused on the associated heart defect, the moment of complete diagnosis related to surgery, and outcome. Coarctation was the most frequently associated heart defect (n = 5) followed by tetralogy of Fallot with or without pulmonary atresia (n = 3). The study group comprised one case of hypoplastic left heart syndrome, one right aortic arch, one congenital mitral malformation, and one infant with divided left atrium and anomalous pulmonary venous return. Only four patients had a complete diagnosis of both the cardiac defect and the coronary abnormality before surgery. In two cases, the coronary anomaly was discovered during surgery performed for another cardiac defect and treated at the same time. The diagnosis of the six remaining patients was determined after cardiac repair. Of the 12 patients, 7 (58 %) died after surgery. Half of these patients died within the first 30 days after repair. At this writing, the remaining patients are in good health after a median follow-up period of 5.4 years (range, 2.1-8.5 years). This study confirmed that ALCAPA associated with other cardiac defects often is misdiagnosed before surgery, mostly due to specific hemodynamics masking myocardial ischemia preoperatively. Survival was compromised due to the unrecognized diagnosis of an associated coronary abnormality but also because of midterm complications related to the other cardiac defects.
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20
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Ma K, Wang L, Hua Z, Yang K, Hu S, Yan J, Zhang H, Pan X, Li S, Chen Q. Outcomes of coronary transfer for anomalous origin of the left coronary artery from the pulmonary artery. Eur J Cardiothorac Surg 2014; 47:659-64. [PMID: 25005837 DOI: 10.1093/ejcts/ezu274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine outcomes of patients presenting with an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) who underwent coronary transfer, and to investigate the role of the left ventricular ejection fraction (LVEF) and preoperative myocardial viability as the predictors for incomplete LV functional recovery. METHODS From 2002 to 2012, 40 consecutive patients whose diagnosis was ALCAPA and who underwent coronary transfer were included. Seventeen patients (42.5%, 17/40) presented with LV dysfunction (Group I) while the other 23 (57.5%, 23/40) did not (Group II). All patients in Group I underwent myocardial perfusion/metabolism imaging and the global viability index was calculated. The mean follow-up time was 54 ± 37 months. RESULTS The median age at repair was 27.6 months (range, 3-66 months) and the mean preoperative LVEF was 49.0 ± 15.6%. Two extracorporeal membrane oxygenation support systems were required after correction. There were no in-hospital deaths and 1 late death. The mean LVEF was significantly improved to 61.0 ± 12.2 and 64.0 ± 11.2% at discharge and follow-up, respectively. Both the LVEF at discharge (52.7 ± 17.1% in Group I versus 66.1 ± 8.0% in Group II, P = 0.02) and the LVEF at the latest follow-up (55.2 ± 10.1% in Group I versus 67.6 ± 8.0% in Group II, P = 0.03) were lower in Group I than Group II. Moderate mitral regurgitations (MRs) were noted in 5 patients (12.8%, 5/39) at follow-up without difference between groups. Restrained functional recovery was observed in 6 patients (35.2%, 6/17) in Group I and the global viability index (P = 0.02) was identified as a predictor for incomplete LV functional recovery. CONCLUSIONS Coronary transfer is a technique of choice with favourable outcomes for this anomaly. In the majority of patients, both ventricular function and MR tend to be normalized over time. Myocardial viability may be an alternative predictor for restrained LV functional recovery.
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Affiliation(s)
- Kai Ma
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lei Wang
- Centre for Pharmacology and Therapeutics, Experimental Medicine, Imperial College London, London, UK
| | - Zhongdong Hua
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Keming Yang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jun Yan
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hao Zhang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiangbin Pan
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qiuming Chen
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Kudumula V, Mehta C, Stumper O, Desai T, Chikermane A, Miller P, Dhillon R, Jones TJ, De Giovanni J, Brawn WJ, Barron DJ. Twenty-Year Outcome of Anomalous Origin of Left Coronary Artery From Pulmonary Artery: Management of Mitral Regurgitation. Ann Thorac Surg 2014; 97:938-44. [DOI: 10.1016/j.athoracsur.2013.11.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 11/03/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
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SCHNEIDER M, WIEBE W, HRAŠKA V, ZARTNER P. Coronary Interventions in Congenital Heart Diseases: From Preterm to Young Adult Patients. J Interv Cardiol 2013; 26:287-94. [DOI: 10.1111/j.1540-8183.2013.12015.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- M. SCHNEIDER
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
| | - W. WIEBE
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
| | - V. HRAŠKA
- Department of Cardiothoracic Surgery; German Pediatric Heart Center; Sankt Augustin; Germany
| | - P. ZARTNER
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
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Callaghan MA, O'Hare B, Casey W. What other anomalies? Failure to wean post ventricular septal defect repair secondary to anomalous origin of the left coronary artery from the pulmonary artery. Paediatr Anaesth 2012; 22:487-9. [PMID: 22229525 DOI: 10.1111/j.1460-9592.2011.03791.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A six week old infant underwent ventricular septal defect and atrial septal defect closure. Preoperative echocardiography showed evidence of pulmonary hypertension. The post operative course was complicated failure to wean from ventilatory and inotropic support. Echocardiography showed severe left ventricular (LV) dysfunction and suggested some fistulous drainage of the left coronary artery into the right pulmonary artery; this anomalous drainage of the left coronary artery into the right pulmonary artery (ALCAPA) was confirmed with coronary angiogram. Re-implantation of the left coronary artery into the aorta was performed. Extra-corporeal membrane oxygenation (ECMO) was required to allow time for ventricular recovery. Supports were weaned gradually, with concurrent evidence of LV recovery and the child was discharged on postoperative day 30. ALCAPA is rare and typically presents at 8 weeks of age with symptoms of heart failure, as pulmonary pressure falls leading to myocardial ischaemia due to myocardial hypoperfusion with relatively desaturated blood. In our case the pulmonary hypertension and left to right shunt preoperatively were protective, maintaining forward flow of relatively oxygenated blood. While protective to the myocardium this made the preoperative diagnosis of ALCAPA difficult, as there was no flow reversal on Doppler echocardiography. Closure of the septal defects meant this protective effect was lost, with subsequent severe myocardial ischaemia and heart failure. This case highlights the diagnostic challenges of ALCAPA, the 'protective' effects of pulmonary hypertension with ALCAPA, and the importance of early cardiac catheterization in the setting of unexplained failure to wean post cardiac surgery.
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Affiliation(s)
- Michael Andrew Callaghan
- Department of Anaesthesia and Intensive Care Medicine, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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González López MT, Gil Jaurena JM, Castillo Martín R, Gutiérrez de Loma J. Use of the Batista procedure to discontinue bypass following aortic reimplantation of an anomalous left coronary artery. J Card Surg 2012; 27:114-6. [PMID: 22321115 DOI: 10.1111/j.1540-8191.2011.01389.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A four-month-old infant with anomalous origin of the left coronary artery from the pulmonary artery developed severe left ventricular failure after aortic reimplantation, despite prolonged supportive cardiopulmonary bypass with high level inotropic support and several abortive attempts for discontinuation. The Batista procedure was performed and the patient was successfully weaned from bypass. Postoperative recovery was uneventful, and at one-year follow-up she remains asymptomatic.
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Affiliation(s)
- M T González López
- Cardiovascular Surgery Department, Carlos Haya Regional Hospital, Málaga, Spain.
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