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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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Ganta S, Artrip J, Schuchardt EL, Lai W, Ryan J, Nigro JJ. Repair of Anomalous Single Coronary Artery From the Pulmonary Artery (ASCAPA). World J Pediatr Congenit Heart Surg 2021; 13:511-514. [PMID: 34928744 DOI: 10.1177/21501351211064157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the management of an infant presenting with severe heart failure at 6 weeks of age found to have an anomalous single coronary artery originating from the main pulmonary artery (MPA). This patient was transferred to our hospital and ultimately had their coronary artery translocated to the ascending aorta successfully. Preoperative severe left ventricular (LV) dysfunction and moderate/severe mitral regurgitation (MR) improved to normal function and mild-to-moderate MR 6 weeks postrepair. Three-dimensional CT reconstructions proved valuable and allowed for accurate preoperative planning leading to successful coronary transfer.
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Affiliation(s)
- Srujan Ganta
- 14444Division of Cardiothoracic Surgery, Rady Children's Hospital, San Diego, CA, USA
| | - John Artrip
- 14444Division of Cardiothoracic Surgery, Rady Children's Hospital, San Diego, CA, USA.,12220Division of Cardiovascular and Thoracic Surgery, University of San Diego (UCSD), School of Medicine, San Diego, CA, USA
| | - Eleanor L Schuchardt
- 12220Department of Pediatrics, University of California San Diego (UCSD), School of Medicine, San Diego, CA, USA
| | - Wyman Lai
- 20209Children's Hospital of Orange County (CHOC), Orange County, CA, USA
| | - Justin Ryan
- 14444Webster Foundation 3DI Lab, Rady Children's Hospital, San Diego, CA, USA
| | - John J Nigro
- 14444Division of Cardiothoracic Surgery, Rady Children's Hospital, San Diego, CA, USA.,12220Division of Cardiovascular and Thoracic Surgery, University of San Diego (UCSD), School of Medicine, San Diego, CA, USA
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Total anomalous origin of the coronary arteries from the pulmonary artery: a systematic review. Cardiol Young 2021; 31:1563-1570. [PMID: 34304753 DOI: 10.1017/s1047951121002997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although rare, coronary artery anomalies can have significant clinical implications. Total anomalous origin of the coronary arteries from the pulmonary artery (TCAPA) represents a rare subtype of coronary artery anomaly for which little is known. The aim of this review was to characterise the presentation, utilised diagnostic modalities, associated cardiac lesions, and treatment strategies in patients with TCAPA. METHODS A systematic review was performed for cases of TCAPA using PubMed, Embase, and Web of Science. Keywords searched included "total anomalous origin of the coronary arteries from the pulmonary artery," "single ostium anomalous coronary artery from the pulmonary artery," and "anomalous origin of both coronary arteries from the pulmonary artery." RESULTS Fifty-seven cases of TCAPA were identified in 50 manuscripts. Fifty-eight per cent of patients were male and the median age at presentation was 10 days (mean 1.71 ± 6.6 years, range 0 days-39 years). Most patients were symptomatic at the time of presentation; cyanosis (n = 22) and respiratory distress (n = 14) were the most common symptoms. Cases were most commonly diagnosed at autopsy (n = 26, 45.6%), but operative intervention was pursued in 22 cases (45.6%); aortic re-implantation (n = 14) and a Takeuchi-type repair (n = 7) were the most common routes of repair. CONCLUSIONS The clinical presentation of patients with TCAPA was found to be variable, likely related to the presence of associated cardiac lesions. TCAPA should be considered in patients with suspected anomalous origin of the left coronary artery from the pulmonary artery for the serious consequences that can occur if not promptly corrected.
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