Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants

Kaźmierczak, Piotr; Ostrowska, Katarzyna; Dryżek, Paweł; Moll, Jadwiga; Moll, J

doi:10.1093/icvts/ivt061

Cited by 27 publications

(20 citation statements)

References 24 publications

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“…Similarly to previously published, smaller series, 8 we decided to focus on infants, since this is a homogenous and distinct group. Having the least developed coronary collaterals, they require urgent treatment after diagnosis and present with various degrees of heart failure.…”

Section: Commentmentioning

confidence: 99%

Outcomes following repair of anomalous coronary artery from the pulmonary artery in infants: results from a procedure-based national database

et al. 2015

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BackgroundAnomalous coronary artery from the pulmonary artery (ACAPA) is a very rare congenital anomaly that often occurs during infancy. Patients can present in a critical condition.MethodsWe analysed procedure-related data from a national audit database for the period 2000–2013.ResultsA total of 120 patients <1 year had repair of isolated ACAPA using a coronary transfer or the tunnel (Takeuchi) operation. Seven patients (6.8%) required a mitral valve procedure at index and eight patients (7.8%) had a mitral valve repair/replacement during follow-up, including mitral reoperations. Follow-up data (>30 days) were available in 102 patients and the mean follow-up time was 4.7 years. The 30-day overall mortality was 1.9%, higher for neonates (16.7% vs 1%, p=0.1) and after postoperative extracorporeal membrane oxygenation (ECMO) (20% vs 1%, p=0.09). At 10 years the survival estimate is 95.1%, freedom from coronary and mitral reintervention being 95.9% and 91.2%, respectively. Use of postoperative ECMO was a risk factor for long-term mortality (p<0.001). Risk factors for coronary reintervention were age under 30 days (p=0.06) and the need for postoperative ECMO (p=0.02). Age under 30 days (p=0.002) was a risk factor for mitral reintervention.ConclusionsTo our knowledge this is the largest series to date. These preliminary national results show that early outcomes are good and medium-term attrition acceptable. Poor outcomes are correlated with early presentation, also with the need for postoperative circulatory support.

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Section: Commentmentioning

confidence: 99%

Outcomes following repair of anomalous coronary artery from the pulmonary artery in infants: results from a procedure-based national database

et al. 2015

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“…However, a small number of patients with late presentation may not show enough improvement of ventricular function owing to the severity of myocardial ischaemia before the operation and also progression of segmental left ventricular dysfunction, which may necessitate mitral valve annuloplasty or mitral valve replacement after the initial surgical correction. 3,4,6 One of the interesting issues among the delayed surgically corrected patients is whether they have segmental left ventricular dysfunction or not, especially in the patients with acceptable ejection fraction in conventional echocardiography.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Nevertheless, left ventricular dysfunction with residual mitral valve regurgitation may necessitate mitral valve repair or replacement. 5,6 Improvement of the left ventricular function is most often overestimated by conventional echocardiographic studies. This method cannot detect the residual myocardial damage and can only assess the global function of the left ventricle with the estimation of ejection fraction.…”

Section: A Nomalous Origin Of the Left Coronarymentioning

confidence: 99%

Role of speckle tracking echocardiography in the assessment of post-repair left ventricular function in patients with late presentation of anomalous origin of the left coronary artery from the pulmonary artery

et al. 2014

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The aim of this study was to determine the left ventricular myocardial deformation and segmental myocardial dysfunction by speckle tracking echocardiography and tissue Doppler imaging among the operated patients with anomalous origin of the left coronary artery from the pulmonary artery. The study was conducted on 12 patients diagnosed with anomalous origin of the left coronary artery from the pulmonary artery, who had been operated upon between 2001 and 2013 at the medical centres of Shiraz University of Medical Sciences, Shiraz, Iran. The mean age of the patients at the time of surgical correction was 12.6 years ranging from 6 months to 43 years, and the duration of postoperative follow-up was between 1 and 12 years. Comparison of the strain rate between the patients with acceptable ejection fraction and the control group by tissue Doppler imaging showed significant differences between the two groups regarding the lateral wall (p<0.001), but not the septal wall of the left ventricle (p=0.65). Moreover, the strain values by the speckle tracking method revealed significant differences between the patient and the control group regarding the global strain (p=0.016) and anterior, lateral, and posterior segments of the left ventricle. Although postoperative conventional echocardiography revealed normal global left ventricular function with acceptable ejection fraction, abnormal myocardial deformation of the variable segments of the left ventricle with regional and global myocardial dysfunction were well defined by speckle tracking echocardiography.

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“…It is the most frequent cause of myocardial infarction in children; mortality among untreated individuals reaches 90%, while the remaining 10% survive due to the existence of collateral circulation from the right coronary artery [ 2 ]. Depending on the extent of the connections between the coronary arteries, BWG syndrome may present itself at elderly age or remain asymptomatic throughout the patient's life [ 2 , 3 ]. Symptoms of congestive heart failure, myocardial ischemia, left ventricular contractility impairments, or impairments in the functioning of the mitral valve typically appear at approximately 8 weeks of life [ 1 – 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Depending on the extent of the connections between the coronary arteries, BWG syndrome may present itself at elderly age or remain asymptomatic throughout the patient's life [ 2 , 3 ]. Symptoms of congestive heart failure, myocardial ischemia, left ventricular contractility impairments, or impairments in the functioning of the mitral valve typically appear at approximately 8 weeks of life [ 1 – 3 ]. The syndrome's subjective manifestations may include dyspnea, fatigability, tearfulness, or paleness [ 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Mechanical circulatory support after surgical repair of Bland-White-Garland syndrome. A study of three cases

Sharma

Augustyn

Nawrocki

et al. 2015

kitp

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The anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA), also known as Bland-White-Garland (BWG) syndrome, is a rare congenital heart disease. We present cases of three children in whom BWG syndrome was repaired surgically. In two of them, the left coronary artery was transplanted from the pulmonary trunk to the aorta, and in one, the Takeuchi procedure was performed. In both cases in which the left coronary artery was transplanted to the aorta, mechanical circulatory support was used after the surgery. This was due to a low ejection fraction (10%) while weaning from cardiopulmonary bypass. Although associated with numerous complications, mechanical circulatory support can be a lifesaving therapy in patients with a poor left ventricular function after the correction of BWG syndrome.

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Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants

Cited by 27 publications

References 24 publications

Outcomes following repair of anomalous coronary artery from the pulmonary artery in infants: results from a procedure-based national database

Outcomes following repair of anomalous coronary artery from the pulmonary artery in infants: results from a procedure-based national database

Role of speckle tracking echocardiography in the assessment of post-repair left ventricular function in patients with late presentation of anomalous origin of the left coronary artery from the pulmonary artery

Mechanical circulatory support after surgical repair of Bland-White-Garland syndrome. A study of three cases

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