Subscribe to RSS
Midterm Surgical Outcomes for ALCAPA Repair in Infants and ChildrenFunding No funding was provided.
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.
Keywordscoronary artery disease - cardiac function - circulatory support devices - anomalous origin of left coronary artery from pulmonary artery - bland–White–Garland
In conclusion, this study demonstrates favorable outcomes of ALCAPA repair with an acceptable mortality rate and a very rare occurrence of secondary surgery. The LVEDD Z-score appears to be a sensitive predictor of death. LV recovery is a long-term process after surgical correction, especially for infants with impaired LV function. Concomitant MV annuloplasty is safe and reliable and can be performed as indicated in patients with moderate or severe MR.
Received: 20 November 2020
Accepted: 27 January 2021
Article published online:
13 April 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Bland EF, White PD, Garland J. Congenital anomalies of the coronary arteries: report of an unusual case associated with cardiac hypertrophy. Am Heart J 1933; 8: 787-801
- 2 Lange R, Vogt M, Hörer J. et al. Long-term results of repair of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 2007; 83 (04) 1463-1471
- 3 Huddleston CB, Balzer DT, Mendeloff EN. Repair of anomalous left main coronary artery arising from the pulmonary artery in infants: long-term impact on the mitral valve. Ann Thorac Surg 2001; 71 (06) 1985-1988 , discussion 1988–1989
- 4 Sese A, Imoto Y. New technique in the transfer of an anomalously originated left coronary artery to the aorta. Ann Thorac Surg 1992; 53 (03) 527-529
- 5 Turley K, Szarnicki RJ, Flachsbart KD, Richter RC, Popper RW, Tarnoff H. Aortic implantation is possible in all cases of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 1995; 60 (01) 84-89
- 6 Nasseri BA, Alexi-Meskishvili V, Nordmeyer S. et al. Predictors for the use of left ventricular assist devices in infants with anomalous left coronary artery from the pulmonary artery. Ann Thorac Surg 2010; 90 (02) 580-587
- 7 Brown JW, Ruzmetov M, Parent JJ, Rodefeld MD, Turrentine MW. Does the degree of preoperative mitral regurgitation predict survival or the need for mitral valve repair or replacement in patients with anomalous origin of the left coronary artery from the pulmonary artery?. J Thorac Cardiovasc Surg 2008; 136 (03) 743-748
- 8 Alexi-Meskishvili V, Nasseri BA, Nordmeyer S. et al. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children. J Thorac Cardiovasc Surg 2011; 142 (04) 868-874
- 9 Kudumula V, Mehta C, Stumper O. et al. Twenty-year outcome of anomalous origin of left coronary artery from pulmonary artery: management of mitral regurgitation. Ann Thorac Surg 2014; 97 (03) 938-944
- 10 Cabrera AG, Chen DW, Pignatelli RH. et al. Outcomes of anomalous left coronary artery from pulmonary artery repair: beyond normal function. Ann Thorac Surg 2015; 99 (04) 1342-1347
- 11 Schmitt B, Bauer S, Kutty S. et al. Myocardial perfusion, scarring, and function in anomalous left coronary artery from the pulmonary artery syndrome: a long-term analysis using magnetic resonance imaging. Ann Thorac Surg 2014; 98 (04) 1425-1436
- 12 Caspi J, Pettitt TW, Sperrazza C, Mulder T, Stopa A. Reimplantation of anomalous left coronary artery from the pulmonary artery without mitral valve repair. Ann Thorac Surg 2007; 84 (02) 619-623 , discussion 623
- 13 Kazmierczak PA, Ostrowska K, Dryzek P, Moll JA, Moll JJ. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants. Interact Cardiovasc Thorac Surg 2013; 16 (06) 797-801
- 14 Alsoufi B, Sallehuddin A, Bulbul Z. et al. Surgical strategy to establish a dual-coronary system for the management of anomalous left coronary artery origin from the pulmonary artery. Ann Thorac Surg 2008; 86 (01) 170-176
- 15 Azakie A, Russell JL, McCrindle BW. et al. Anatomic repair of anomalous left coronary artery from the pulmonary artery by aortic reimplantation: early survival, patterns of ventricular recovery and late outcome. Ann Thorac Surg 2003; 75 (05) 1535-1541
- 16 Cochrane AD, Coleman DM, Davis AM, Brizard CP, Wolfe R, Karl TR. Excellent long-term functional outcome after an operation for anomalous left coronary artery from the pulmonary artery. J Thorac Cardiovasc Surg 1999; 117 (02) 332-342
- 17 Imamura M, Dossey AM, Jaquiss RD. Reoperation and mechanical circulatory support after repair of anomalous origin of the left coronary artery from the pulmonary artery: a twenty-year experience. Ann Thorac Surg 2011; 92 (01) 167-172 , discussion 172–173