Anomalous origin of the left coronary artery from the pulmonary artery: repair by aortic reimplantation

Abstract

From 1980 to 1990, 12 patients (mean age 2.5 years, range 5 months to 9 years) with anomalous origin of the left coronary artery from the pulmonary artery were treated surgically. Five infants were operated upon in the first year of life because of persistent symptoms of congestive heart failure. In all cases, a two-coronary system was constructed by direct aortic reimplantation of the anomalous vessel with no deaths early or late over a follow-up period of up to 10 years. The technique of reimplantation was facilitated by transection of the main pulmonary artery. One patient with severe mitral regurgitation underwent, in addition, a mitral annuloplasty. A pulmonary valvotomy was performed in another patient with associated pulmonary stenosis. Three patients are receiving medication. The reimplanted anomalous left coronary artery was patent in each reevaluated patient (10/12). Left ventricular function improved considerably in all cases. Patients with symptoms should undergo repair soon after diagnosis. Direct aortic reimplantation should be technically feasible in even the smallest infant. Operative mortality is related to preoperative conditions and severity of ischemic damage of the myocardium.

Nacimiento anómalo de la arteria coronaria izquierda desde la arteria pulmonar, síndrome de ALCAPA. Primer reporte de caso en Uruguay

“…El tratamiento del síndrome de ALCAPA es quirúrgico. Se han descrito varias técnicas, siendo las más aceptadas por sus mejores resultados: el reimplante de la ACI en la aorta con la restauración de una circulación coronaria dependiente de un circuito de dos arterias (8) y la ligadura del tronco coronario izquierdo con bypass de la arteria mamaria interna izquierda a la ADA. Debido a sus buenos resultados la técnica del reimplante de la ACI en la aorta es la de elección en la infancia, mientras que en el adulto se prefiere la ligadura de la ACI con la realización de bypass arterial o venoso (9,10) .…”

Anomalous coronary artery originating from the pulmonary artery: a report of four cases

“…Ameliyat mortalitesi uygulanan ameliyat tekniğine bağlı olup %0-23 arasında değişmektedir. [4][5][6][7][8][9][10][11][12][13][14][15][16] Zheng ve ark. [6] tarafından yapılan çalışmada cerrahi tedavi uygulanan 21 olgunun altısı (%28.5) cerrahi sonrası erken dönemde kaybedilmiştir.…”

An alternative technique for transfer of anomalous left coronary artery from the pulmonary trunk in children and adults using autogenous aortic and pulmonary arterial flaps

“…Creation of a dual coronary arterial system in the preferred option for surgical repair in patients with anomalous origin of the left coronary artery from the pulmonary trunk. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] It eliminates the ''steal'' phenomenon, and restores physiological antegrade flow to the ischaemic left ventricular myocardium. Available surgical procedures include direct coronary arterial re-implantation, the intrapulmonary tunnel repair, prolongation of flaps of pulmonary arterial wall with or without anastomosis to the right subclavian artery, left sulclavian artery-to-left coronary artery anastomosis, and ligation with saphenous venous interposition, and anastomosis of the left internal thoracic artery to the left anterior interventricular artery.…”

“…Available surgical procedures include direct coronary arterial re-implantation, the intrapulmonary tunnel repair, prolongation of flaps of pulmonary arterial wall with or without anastomosis to the right subclavian artery, left sulclavian artery-to-left coronary artery anastomosis, and ligation with saphenous venous interposition, and anastomosis of the left internal thoracic artery to the left anterior interventricular artery. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Direct implantation of the left coronary artery into the ascending aorta is the preferred option, 2,7,9,[16][17][18][19] and is usually performed on the left postero-lateral wall of the ascending aorta from outside. For optimal exposure of this aspect of the aorta, two ingenious techniques have been described, namely transection of the pulmonary trunk, 20 and an anterior aortic approach, anastomosing the excised button of pulmonary trunk from within the lumen of the aorta under direct visualization.…”

“…To overcome the limitations of these procedures, a variety of techniques have been described to elongate the main stem of the left coronary artery, 3,[12][13][14][15][16] each having inherent advantages and disadvantages. 3,[12][13][14][15] Our modification of the trapdoor technique involves detachment of the anomalous left coronary artery from the pulmonary arterial sinus, elongation using autogenous, viable, endothelialized aortic and pulmonary arterial flaps, side-to-side anastomosis of the aortic and pulmonary arterial Figure 9.…”