Long-term outcome after anomalous left coronary artery from the pulmonary artery repair: a 40-year single-centre experience

Lange, Rüdiger; Cleuziou, Julie; Krane, Markus; Ewert, Peter; Ohain, Jelena Pabst von; Beran, Elisabeth; Vitanova, Keti

doi:10.1093/ejcts/ezx407

Cited by 25 publications

(20 citation statements)

References 28 publications

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“…Among the survived patients, the EF improved markedly in the last follow-up compared to the preoperative value. This finding was consistent with a study conducted over 40 years in patients aged less than 1 year and showed a preoperative EF < 35% in 71% patients, and the last follow-up EF > 50% in 84% [16]. Infants with ALCAPA presents with depressed myocardial function due to poor collaterals and restoring myocardial blood flow improved the function markedly.…”

Section: Discussionsupporting

confidence: 91%

The outcome of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in infants

Moshref

Faden

et al. 2019

Cardiothorac Surg

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Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation in infants presenting with angina, dyspnea, and excessive perspiration invoked by crying and feeding. The aim of this study was to evaluate the factors affecting morbidity and the use of extracorporeal membrane oxygenation (ECMO) and to assess the quality of life post-repair. Methods: In this retrospective study, information about five infants who underwent ALCAPA repair was collected from the databases of two tertiary referral cardiac centers () from 2011 to 2018. The patients were diagnosed using echocardiography, and data including mitral insufficiency and ejection fraction were assessed preoperatively and postoperatively. Quality of life was assessed using a questionnaire-based interview. Results: The median (range) age at the time of repair was 95 (34-144) days, and the median weight was 4.9 (3-5.7) kg. Two patients underwent the Takeuchi procedure, and three patients underwent left coronary artery reimplantation and translocation to the aorta. The median preoperative ejection fraction was 25 (12.5-45)%, and at the last follow-up, the median EF of the three survivors was 59 (50-70)%. There was no significant change in mitral insufficiency grade postoperatively. Two patients had ECMO support and died postoperatively. The infants who died were younger (< 75 days) and had lower weight (< 4.5 kg) at the time of intervention. Patients who survived showed good quality of life were asymptomatic and had heart function within the normal range. Conclusion: Echocardiography and CT angiogram are effective tools for ALCAPA diagnosis in pediatric patients. Low weight at time or repair was associated with increased morbidity and ECMO did not increase survival.

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Section: Discussionsupporting

confidence: 91%

The outcome of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in infants

Moshref

Faden

et al. 2019

Cardiothorac Surg

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“…Authors indicated that MR remained constant or recovered slower in adult patients and infants between six months to 1‐year‐old age group. However, age at initial operation could not be identified as a risk factor for persisting MR in reports 8,17,18 . In our cohort, all adult patients with at least moderate MR showed significant recovery contrary to Neumann et al 17 The only factor which estimated persistent MR was preoperative at least moderate MR.…”

Section: Discussioncontrasting

confidence: 77%

“…However, proponents of concomitant repair have demonstrated the safety of this approach 14,15 . Some centers favor concomitant mitral repair only when the valve is structurally defected 6,8,16 . In our study, preoperative moderate or higher MR predicted MR at the last follow‐up.…”

Section: Discussionmentioning

confidence: 57%

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Anomalous left coronary artery from the pulmonary artery repair outcomes: Preoperative mitral regurgitation persists in the follow‐up

et al. 2020

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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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“…While early direct reimplantation of the anomalous LMCA into the aorta is the treatment of choice for infantile type [ 11 ], the optimal surgical management of ALCAPA in adults is still a debatable issue [ 2 ]. Various surgical methods have been introduced, including ligation of the anomalous LMCA, CABG, Takeuchi’s procedure, and reimplantation of the LCMA to aorta [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Anomalous left coronary artery from the pulmonary artery (ALCAPA) as a concealed cause of severe mitral regurgitation in children and adults: Case reports

Nguyen

Cao

Thao

et al. 2020

International Journal of Surgery Case Reports

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Highlights ALCAPA can be the cause of severe MR but this diagnosis can be missed. ALCAPA should be looked for in patients with severe MR with unexplained causes. Signs of chronic cardiac ischemia and increased coronary collaterals suggest ALCAPA. The surgical strategy for coronary corrective repair should be carefully planned.

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Long-term outcome after anomalous left coronary artery from the pulmonary artery repair: a 40-year single-centre experience

Cited by 25 publications

References 28 publications

The outcome of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in infants

The outcome of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in infants

Anomalous left coronary artery from the pulmonary artery repair outcomes: Preoperative mitral regurgitation persists in the follow‐up

Anomalous left coronary artery from the pulmonary artery (ALCAPA) as a concealed cause of severe mitral regurgitation in children and adults: Case reports

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