Surgical Strategy to Establish a Dual-Coronary System for the Management of Anomalous Left Coronary Artery Origin From the Pulmonary Artery

Alsoufi, Bahaaldin; Sallehuddin, Ahmed; Bulbul, Ziad; Joufan, Mansour; Khouqeer, Fareed; Canver, Charles C.; Kalloghlian, Avedis; Al‐Halees, Zohair

doi:10.1016/j.athoracsur.2008.03.032

Cited by 52 publications

(41 citation statements)

References 14 publications

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“…Most centers recommend not addressing mitral regurgitation, even severe, at initial surgery [1,[6][7][8]10,15], whereas a few others advocate routine mitral valve repair [9,16]. Our own policy has been to avoid concomitant mitral valve repair, except in selected patients with evidence of irreversible damage to the papillary muscles.…”

Section: Fate Of the Mitral Valvementioning

confidence: 97%

“…The mechanism of mitral regurgitation is related more to ischemic lesions of the papillary muscles than to enlargement of the mitral annulus. Mitral valvuloplasty, in association with ALCAPA repair, is then indicated, because the likelihood of regression of mitral regurgitation with coronary revascularization alone is low [16]. Restrictive annuloplasty using absorbable material may be a satisfactory option.…”

Section: Fate Of the Mitral Valvementioning

confidence: 98%

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Anomalous origin of the left coronary artery from the pulmonary artery: late results with special attention to the mitral valve☆

Ali

Metton

Roubertie

et al. 2009

European Journal of Cardio-Thoracic Surgery

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(1) Early mortality is related to the severity of preoperative left ventricular dysfunction; it may be reduced by a careful use of postoperative cardiac support techniques. (2) Late results are satisfactory and left ventricular function always recovers. (3) Mitral regurgitation improves along with left ventricular function, but recovery may be incomplete and need reoperation. The data suggest that mitral valve surgery is probably not indicated at initial surgery, except in selected cases with a low potential of recovery (severe regurgitation with relatively well-preserved left ventricular function).

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Section: Fate Of the Mitral Valvementioning

confidence: 97%

Section: Fate Of the Mitral Valvementioning

confidence: 98%

Anomalous origin of the left coronary artery from the pulmonary artery: late results with special attention to the mitral valve☆

Ali

Metton

Roubertie

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…The other is creating an aortopulmonary window that directs blood flow from the aorta to the LCA (Takeuchi). After those procedures, no matter how impaired the ventricular functions had been, myocardial function can quickly heal [12,13] .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Anomalous Coronary Arteries from the Pulmonary Artery

Güzeltaş¹,

Öztürk²,

Öztürk³

et al. 2017

Braz J Cardiovasc Surg

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ObjectiveThis study evaluated clinical and diagnostic findings, treatment methods, and follow-up of cases of anomalous coronary arteries from the pulmonary artery.MethodsThe study included all cases diagnosed with anomalous coronary arteries from the pulmonary artery between January 2012 and January 2016. Data from patients’ demographic characteristics, electrocardiography, echocardiography, angiographic findings, operation, intensive care unit stay, and follow-up were evaluated.ResultsThe study included 12 patients (8 male, 4 female), 10 with anomalous left coronary artery from the pulmonary artery (ALCAPA) and 2 with anomalous right coronary artery from the pulmonary artery (ARCAPA). Median age at diagnosis was 4 months (range, 1 month - 10 years old) and median weight was 5.5 kg (range, 3-30 kg). The most common complaints were murmur (n=7) and respiratory distress (n=5). In 4 cases, the initial diagnosis was dilated cardiomyopathy. Electrocardiographs were pathologic in all cases. Echocardiographic examination revealed medium to severe mitral valve regurgitation in 4 cases and reduced (< 40%) ejection fraction in 6 patients. Of the 12 patients, 8 underwent direct implantation of the left coronary artery into the aorta, 2 underwent implantation of the right coronary artery into the aorta, and the remaining 2 underwent a Takeuchi procedure. There were no early mortalities. Median hospital stay was 20 days (range, 5-35 days). Median follow-up duration was 18 months (range, 5-36 months), and no cases required further surgery during follow-up.ConclusionsAnomalous coronary arteries from the pulmonary artery can be successfully repaired providing there is early diagnosis and effective, appropriate intensive care unit follow-up. Therefore, coronary artery origins should be evaluated carefully, especially in cases with dilated cardiomyopathies.

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“…In the LCA button transfer technique, the anastomosis should be tension free without any kinks. Because extended LCA dissection can injure branch vessels, modified operational techniques have been used by various centers, including adjustment of the position of the anastomosis in accordance with the origin of the LCA [8] or creation of a pulmonary artery flap to increase the length [7,13–16]. We have used the pulmonary artery tube flap and aortic trapdoor techniques.…”

Section: Discussionmentioning

confidence: 99%

An Alternative Surgical Technique for Repair of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

Kim

Lee

Cho

et al. 2014

Korean J Thorac Cardiovasc Surg

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BackgroundFor the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA.MethodsBetween October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed.ResultsThere was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement.ConclusionOur modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA.

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Surgical Strategy to Establish a Dual-Coronary System for the Management of Anomalous Left Coronary Artery Origin From the Pulmonary Artery

Cited by 52 publications

References 14 publications

Anomalous origin of the left coronary artery from the pulmonary artery: late results with special attention to the mitral valve☆

Anomalous origin of the left coronary artery from the pulmonary artery: late results with special attention to the mitral valve☆

Evaluation of Anomalous Coronary Arteries from the Pulmonary Artery

An Alternative Surgical Technique for Repair of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

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