Outcomes of Anomalous Left Coronary Artery From Pulmonary Artery Repair: Beyond Normal Function

Cabrera, Antonio G.; Chen, Diane W.; Pignatelli, Ricardo H.; Khan, Muhammad S.; Jeewa, Aamir; Mery, Carlos M.; McKenzie, E. Dean; Fraser, Charles D.

doi:10.1016/j.athoracsur.2014.12.035

Cited by 67 publications

(51 citation statements)

References 27 publications

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“…Our finding of abnormal LV torsion and longitudinal deformations are in agreement with previous studies showing reduced exercise performance and stress perfusion defects in asymptomatic long-term survivors after successful ALCAPA repair [6,7]. …”

Section: Discussionsupporting

confidence: 82%

“…The treatment of choice is surgical left main coronary artery reimplantation into the aorta [3]. Data regarding long-term follow-up are limited and despite apparent good left ventricle (LV) systolic function, as assessed by standard echocardiography, follow-up complications such as persistent mitral regurgitation, congestive heart failure, and coronary stenosis may necessitate reinterventions, including heart transplantation [4,5,6,7]. Advanced echocardiographic technique, such as speckle tracking echocardiography (STE), allows angle-independent assessment of cardiac mechanics and has demonstrated in several studies the ability to detect early subclinical myocardial abnormalities, even in the presence of normal LV ejection fraction (EF) [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Left Ventricular Mechanics in Patients with Abnormal Origin of the Left Main Coronary Artery from the Pulmonary Trunk Late after Successful Repair

Salvo

Siblini²,

Issa³

et al. 2016

Cardiology

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Objective: Our aim was to evaluate left ventricular (LV) mechanics by using speckle tracking echocardiography (STE) in asymptomatic patients with abnormal origin of the left main coronary artery from the pulmonary trunk (ALCAPA), late after successful repair, in the presence of LV ejection fraction (EF) >50%. Methods: We studied 30 ALCAPA patients (median age 4 years, range 1-25 years, NYHA class I, LVEF >50%) and 16 healthy age- and sex-matched controls (median age 5 years, range 1-25 years). All underwent standard echocardiographic evaluation and STE. Results: LV dimensions and LVEF (63.6 ± 8.2% vs. 64.1 ± 5.1%, p = 0.826) were not different between patients and controls. Diastolic parameters were significantly abnormal in our patients versus controls (E/e' average: 11.9 ± 5.8 vs. 6.6 ± 3.0, p = 0.0014). Global LV longitudinal strain was significantly lower in ALCAPA patients versus controls (-17.6 ± 3.5% vs. -23.4 ± 3.1%, p < 0.0001). LV torsion (9.1 ± 4.9° vs. 11.9 ± 3.3°, p = 0.046) was significantly impaired in ALCAPA patients. Conclusions: After successful repair in asymptomatic ALCAPA patients, despite an LVEF >50%, diastolic function, LV longitudinal deformation and LV torsion remain impaired. We suggest including a detailed study of the diastolic function and cardiac mechanics in the clinical follow-up of these patients to identify the subgroup of patients at higher risk.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Left Ventricular Mechanics in Patients with Abnormal Origin of the Left Main Coronary Artery from the Pulmonary Trunk Late after Successful Repair

Salvo

Siblini²,

Issa³

et al. 2016

Cardiology

View full text Add to dashboard Cite

show abstract

“…An aortopulmonary window was created, and the pulmonary artery flap was used to baffle the left coronary artery into the aorta. The pulmonary artery was then reconstructed with autologous pericardium [5–7]. …”

Section: Methodsmentioning

confidence: 99%

“…However, to the patients with the origin of the LCA far away from the aortic root the coronary ostium was excised along with a strip of the pulmonary artery wall. Autologous pericardium was used to reconstruct the posterior wall of this “elongated” coronary artery and the neo-ostium was then anastomosed end-to-side with the ascending aorta [5, 8, 9]. …”

Section: Methodsmentioning

confidence: 99%

“…However, some adult type patients do not present with symptoms until later in life. These older patients often manifest their anomalies as mitral regurgitation (MR), ischemic cardiomyopathy, malignant dysrhythmias, or even sudden death [4, 5]. So a diagnosis of ALCAPA indicates immediate surgical intervention regardless of the age level except for the newborn.

Fig.…”

Section: Introductionmentioning

confidence: 99%

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Midterm outcome after surgical correction of anomalous left coronary artery from the pulmonary artery

Bhushan

Fan

et al. 2016

J Cardiothorac Surg

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BackgroundThis study was undertaken to determine the midterm outcome in patients with anomalous left coronary artery from the pulmonary artery (ALCAPA) undergoing coronary reimplantation and Takeuchi repair.MethodsA retrospective review of patients who had ALCAPA repair between January 2009 and December 2015. Mortality, echocardiography assessment of left ventricular function including ejection fractionand, shortening fraction, severity of mitral regurgitation, stenosis of the coronary ostium were studied retrospectively.ResultsSixteen patients were described. The mean age at the time of surgery was 22.5 ± 10.3 years (range, 9 months-35.6 years) and 2 patients were younger than 1 year old, Surgical interventions included left coronary artery reimplantation in 13 patients (81 %) and Takeuchi repair in 3 (19 %). Concomitant mitral valve repair was performed in 2 cases, no cases required mechanical circulatory support postoperatively. There was no mortality. At median follow-up of 4.6 years, EF improved from 33.2 % ±6.8 % to 60.9 % ± 8.1 % (p <0.05), mean SF from 28.5 % ± 12.1 % to 40.2 % ± 5.4 % (p <0.05). Only one patient was with moderate mitral regurgitation. All 16 cases had normal ejection fraction and shortening fraction without stenosis of the coronary ostium at last follow-up.ConclusionsEarly establishment of a 2-coronary artery achieved excellent outcomes without morbidity and mechanical circulatory support. Normal ejection fraction and shortening fraction recovered smoothly. There is no stenosis of the coronary ostium at the midterm follow-up.

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Congenital Anomalies of the Mitral Valve

Choi

Emani

2023

Pediatric Cardiac Surgery

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Outcomes of Anomalous Left Coronary Artery From Pulmonary Artery Repair: Beyond Normal Function

Cited by 67 publications

References 27 publications

Left Ventricular Mechanics in Patients with Abnormal Origin of the Left Main Coronary Artery from the Pulmonary Trunk Late after Successful Repair

Left Ventricular Mechanics in Patients with Abnormal Origin of the Left Main Coronary Artery from the Pulmonary Trunk Late after Successful Repair

Midterm outcome after surgical correction of anomalous left coronary artery from the pulmonary artery

Congenital Anomalies of the Mitral Valve

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