Thorac Cardiovasc Surg 2007; 55 - P_61
DOI: 10.1055/s-2007-967616

Anomalous origin of the left coronary artery from the pulmonary artery: Mid-term results after surgical correction

W Kuroczynski 1, D Pruefer 1, C Kampmann 2, N Kayhan 1, C Martin 2, M Heinemann 1, CF Vahl 1
  • 1University Clinic Mainz, Dept. of Cardiothoracic and Vascular Surgery, Mainz, Germany
  • 2University Clinic Mainz, Dept. of Pediatric Cardiology, Mainz, Germany

Objective: Children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) are at risk for myocardial infarction and death. This retrospective study shows the mid-term follow-up after the use of aortic implantation and alternative methods to achieve coronary transfer.

Methods: Since 1990 seven children underwent primary repair of ALCAPA. Age at operation ranged from 2 to 71 months. 6 patients had a cardiac murmur and 5 suffered from severe congestive heart failure. Operative techniques – ligation (n=1), intrapulmonary tunnel (n=1), and aortic implantation (n=5). One patient with severe mitral valve incompetence underwent additional mitral valve replacement. A 4-month-old patient was successfully treated after the operation with LVAD. A delayed sternal closure was necessary in one patient.

Results: One death occurred at 2 weeks after intrapulmonary tunnelling. In surviving patients with two-vessel coronary blood supply the preoperatively depressed left ventricular ejection fraction returned to normal, left ventricular end-diastolic volume decreased after operation and returned to near normal values 2 to 12 months postoperatively. One patient after ligation received additional mitral valve replacement. Recovery was prolonged and left ventricular performance remained reduced (EF 50%). The mitral valve incompetence decreased in all patients with a native mitral valve.

Conclusion: It is always preferable to create a two-coronary artery system with antegrade flow. Mitral valve annuloplasty, or implantation is recommended for patients with severe mitral valve incompetence. The early use of left ventricular assist devices in the postoperative low outpout period may result in a better postoperative outcome.