Regional and global left ventricular function in infants with anomalous origin of the left coronary artery from the pulmonary trunk: preoperative and postoperative assessment.

Rein, Azaria J.J.T.; Colan, S. D.; Parness, Ira A.; Sanders, Stephen P.

doi:10.1161/01.cir.75.1.115

Cited by 76 publications

(28 citation statements)

References 35 publications

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“…The hypothesis suggests myocytes supplied by the ALCAPA undergo an adaptive change and become hypokinetic rather than necrotic despite being hypoperfused [8] . The function and viability of the cardiomyocytes is preserved because of the successful formation and utilization of a compensatory but inadequate collateral supply.…”

Section: Discussionmentioning

confidence: 99%

Late intervention in an asymptomatic pediatric patient with anomalous left coronary artery

Lam¹

2014

WJC

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Anomalous left coronary artery from the pulmonary artery (ALCAPA) is most commonly diagnosed within the first year of life with congestive heart failure symptomatology reflecting left ventricle (LV) dysfunction. The late diagnosis of ALCAPA is presented in a 5-yearold without significant LV dysfunction, mild LV dilatation and only mild mitral regurgitation that did not change significantly after surgery. The timing of surgical intervention in the late diagnosis of ALCAPA remains unclear despite risks of significant ongoing myocardial injury secondary to coronary artery hypoperfusion and progressive mitral valve dysfunction. Intervention in this case allows for revascularization which may reverse ventricular and valvular dysfunction. Key words: Congenital heart disease; Congenital heart surgery; Coronary artery imaging; Coronary artery surgery; Reperfusion Core tip: This case report presents the rare case of a late diagnosis of anomalous left coronary artery from the pulmonary artery and the associated challenge with determining the need for surgical revascularization in the absence of symptomatology and definitive literature. Late surgical intervention undertaken in this patient may reverse ongoing myocardial dysfunction and prevent permanent left ventricular damage.Lam JC, Giuffre M, Myers KA. Late intervention in an asymptomatic pediatric patient with anomalous left coronary artery.

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Section: Discussionmentioning

confidence: 99%

Late intervention in an asymptomatic pediatric patient with anomalous left coronary artery

Lam¹

2014

WJC

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“…Previous studies about the assessment of left ventricular function in patients with ALCA used twodimensional echocardiography [9] and thallium 201 perfusion [2,8] at rest. Rein et al [9] studied the regional motion of 11 patients with ALCA and found global hypokinesis rather than localized disturbances.…”

Section: Discussionmentioning

confidence: 99%

“…Rein et al [9] studied the regional motion of 11 patients with ALCA and found global hypokinesis rather than localized disturbances. Gutgesell et al [2] found localized abnormalities in all the patients studied with thallium 201 myocardial prefusion imaging, whereas Rabinovitch et al [8] described normal perfusion in an asymptomatic patient.…”

Section: Discussionmentioning

confidence: 99%

Dobutamine Stress Echocardiography in Anomalous Left Coronary Artery

et al. 1998

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The evaluation of left ventricular function with dobutamine stress echocardiography is described for the first time in a patient with anomalous left coronary artery from the pulmonary trunk during the preoperative and postoperative periods. This method demonstrated signs of myocardial ischemia that were not seen on the resting echocardiogram during the preoperative period and ventricular function recovery after surgical intervention.

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“…The left ventricular dysfunction is global. There is no specific regional wall motion abnormality [31]. All of these findings may be seen with myocarditis and dilated cardiomyopathy in addition to the ALCAPA syndrome.…”

Section: Imaging Preoperativelymentioning

confidence: 96%

“…Postoperatively, prograde flow from the aorta into the left main coronary artery is affirmed. Recovery of left ventricular function and improvement of mitral regurgitation are followed with serial examinations [31].…”

Section: Imaging Intraoperatively and Postoperativelymentioning

confidence: 99%

Congenital Anomalies of the Coronary Arteries

Herlong

2009

Echocardiography in Pediatric and Congenital Heart Disease

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The term coronary derives from the Latin root coronarius, which means crown. Indeed, the coronary arteries sit on the heart as a crown, and they are the "crowning subject" of adult cardiology due to the prevalence of acquired coronary artery disease. Although less of a preeminent subject in pediatric cardiology, coronary artery anomalies, with and without concomitant structural congenital heart disease, are an important topic for the pediatric cardiologist. This chapter reviews echocardiography of congenital coronary artery anomalies of importance to the pediatric cardiologist. Material pertinent to all congenital coronary artery anomalies is presented first, followed by material particular to each important anomaly. Developmental considerationsBefore the development of the coronary arteries, the loosely packed myocardium of the embryonic heart is nourished by sinusoids throughout the heart cavities. As the myocardium becomes more compact, veins, arteries and capillaries develop from these primitive sinusoids. Then, at around 32 days of gestation, subepicardial vascular networks develop; shortly thereafter, endothelial buds appear at the base of the truncus arteriosus. These two anlagen join to one another by around 45 days of gestation, and the definitive coronary arterial circulation is thus established.Controversy exists regarding the number of endothelial buds present at the base of the truncus arteriosus and the manner in which the two coronary anlagen (subepicardial vascular networks and endothelial buds) connect with one another. Abrikossoff originally described two endothelial buds that were "allotted" to the aorta by division of the truncus into aorta and pulmonary artery [1]. Hackensellner later suggested that there are endothelial buds in each of the six sinuses of Valsalva of the great arteries and that all but two of these ultimately involute [2]. The latter theory has better withstood subsequent investigation [3], but either theory may readily explain the multitude of coronary artery anomalies that exist. The method of involution and induction of the appropriate sinuses of Valsalva remains speculative [4]. Normal coronary anatomyThere are normally two major coronary arteries, which originate from the right and left aortic sinuses of Valsalva. These sinuses are small outpouchings of the aorta between the sinotubular junction and the aortic valve leaflets. There are normally three such sinuses; the third, or posterior, sinus of Valsalva, is usually devoid of a coronary artery orifice. It is thus called the noncoronary sinus of Valsalva. The left coronary arteryThe left main coronary artery arises from the left sinus of Valsalva and courses only a short distance (<4 cm in the adult) before dividing into the left circumflex and left anterior descending coronary arteries (Fig. 29.1). The left circumflex coronary artery varies considerably in size depending on whether the posterior descending coronary artery is a branch of the right coronary artery (right-dominant coronary system) or a branch of the circu...

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Regional and global left ventricular function in infants with anomalous origin of the left coronary artery from the pulmonary trunk: preoperative and postoperative assessment.

Cited by 76 publications

References 35 publications

Late intervention in an asymptomatic pediatric patient with anomalous left coronary artery

Late intervention in an asymptomatic pediatric patient with anomalous left coronary artery

Dobutamine Stress Echocardiography in Anomalous Left Coronary Artery

Congenital Anomalies of the Coronary Arteries

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