Surgical treatment of anomalous origin of the left coronary artery in infancy and childhood

Laborde, F; Marchand, M; Leca, F; Jarreau, Marie‐Madeleine; Dequirot, A; Hazan, E

doi:10.1016/s0022-5223(19)39332-8

Cited by 33 publications

(5 citation statements)

References 11 publications

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“…Several surgical procedures have been described, initially palliative, but more recently restoring a 2-coronary system, including various forms of bypass graft from the aorta, 2,3 subclavian artery anastomosis, 4 intrapulmonary bypass graft, 5 intrapulmonary artery baffle, 6 and direct coronary translocation to the aorta. [7][8][9] What remains controversial is whether to surgically treat MR at the time of ALCAPA repair. In ALCAPA, even severe MR has been reported to fully regress after reimplantation of the left coronary artery (LCA) into the aorta.…”

Section: Discussionmentioning

confidence: 99%

Does the degree of preoperative mitral regurgitation predict survival or the need for mitral valve repair or replacement in patients with anomalous origin of the left coronary artery from the pulmonary artery?

Brown¹,

Ruzmetov²,

Parent

et al. 2008

The Journal of Thoracic and Cardiovascular Surgery

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Background: Anomalous origin of the left coronary artery from the pulmonary artery causes severe myocardial ischemia, global left ventricular dysfunction, and annular dilatation producing varying degrees of mitral regurgitation. Mitral regurgitation secondary to the left ventricular or papillary muscle dysfunction in infants will usually improve in the absence of ongoing ischemia. The aim of this study is to determine the influence of the degree of preoperative mitral regurgitation on the early and late outcomes of patients with anomalous origin of the left coronary artery from the pulmonary artery who underwent coronary reimplantation.Methods: Twenty-five patients underwent coronary reimplantation and 1 early patient had ligation during a 30-year period (median age, 4 months; range, 1 month to 16 years), with a median follow-up of 7 years (range, 4 months to 25 years). Before repair, 7 infants (27%) presented in extremis requiring ventilatory and inotropic support, and 17 patients (65%) presented with heart failure. Mitral regurgitation was present in all patients: trivial in 6 patients, mild in 12 patients, moderate in 5 patients, and severe in 3 patients. No patient underwent mitral valve repair or replacement at the time of anomalous origin of the left coronary artery from the pulmonary artery repair.Results: Hospital survival was 92%. Three patients underwent mitral valve repair or replacement at the mean time of 3.5 years (all with severe preoperative mitral regurgitation). The degree of mitral regurgitation gradually improved in all remaining patients with preoperative mild and moderate mitral regurgitation. Echocardiographic studies demonstrated improvement in left ventricular function in all children. None of the patients showed any evidence of supravalvar pulmonary stenosis as a result of their pulmonary artery reconstruction.

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Section: Discussionmentioning

confidence: 99%

Does the degree of preoperative mitral regurgitation predict survival or the need for mitral valve repair or replacement in patients with anomalous origin of the left coronary artery from the pulmonary artery?

Brown¹,

Ruzmetov²,

Parent

et al. 2008

The Journal of Thoracic and Cardiovascular Surgery

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show abstract

“…Mitral regurgitation is thought to result from the dysfunction of the ischemic papillary muscles and adjacent myocardium. Rarely, mitral regurgitation is due to prolapse or an associated lesion such as mitral cleft or short chordae [ 14 ]. In our case severe regurgitation was due more to myxomatous degeneration of the mitral valve than ischaemic mitral regurgitation, as indicated by the pathological findings of the excised valve.…”

Section: Discussionmentioning

confidence: 99%

A long-term survivor of Bland-White-Garland syndrome with systemic collateral supply: A case report and review of the literature

Barbetakis¹,

Efstathiou²,

Efstathiou³

et al. 2005

BMC Surg

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Backgroundland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a rare disease which may result in myocardial infarction, congestive heart failure and sometimes death during the early infantile period. Case presentation: A succesfully treated case of a 45-year-old mother of 2 children with Bland-White-Garland syndrome and concomitant severe mitral regurgitation is presented. Subsequent therapy consisted of ligation of the anomalous origin of the left coronary artery, anastomosis of the left internal mammary artery to the left anterior descending branch and mitral valve replacement. Continuous blood flow from the left coronary artery ostium during extracorporeal circulation and aorta clamping suggested systemic collateral supply. Conclusions: Recognition and diagnosis of Bland-White-Garland syndrome is important due to its potentially life-threatening complications.

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“…From January 1975 to January 1987, 21 consecutive infants (three weeks to six months old, mean (SD) [2][3][4][5][6] (1 2) months) were admitted to our department during or soon after a myocardial infarction caused by an anomalous left coronary artery arising from the pulmonary artery.…”

Section: Methodsmentioning

confidence: 99%

Anomalous left coronary artery arising from the pulmonary artery in infancy: is early operation better?

Guikahue

Sidi

Kachaner

et al. 1988

Heart

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21 consecutive infants aged less than six months (mean (SD) 2-6 (1 2)) were admitted with anomalous origin of the left coronary artery from the pulmonary artery. In the first 12 patients, who were seen up to 1982, operation was performed after the age of one year (mean (SD) 29 (29) months) (group 1). The next nine infants, seen from 1983 to 1987, had their operations within a few weeks of the onset of symptoms (mean (SD) age 4-8 (1 4) months) (group 2). In group 2 the left coronary artery was relocated into the aorta, whereas in group 1 there was additional resection of the left ventricular wall or mitral valvoplasty or both. At presentation there were no differences in age, clinical condition, heart enlargement, and echocardiographic left ventricular dysfunction between groups 1 and 2. Seven of the 12 patients in group 1 died, five while they were awaiting operation (three died suddenly at home) and two at operation. The five survivors are doing well 6-4 (3-1) years after operation with normal left ventricular function which improved slowly over several months after operation. Two of the nine patients in group 2 died; both deaths occurred at or soon after operation. The seven survivors are doing well 1 8 (0 9) years after operation. In three, left ventricular function recovered within three weeks; and there was even partial or total regression of the Q waves in the supposedly necrotic areas. In the remaining four the pattern of improvement in left ventricular function resembled that in group 1.Operation should be undertaken early in infants with anomalous left coronary artery arising from the pulmonary artery because the procedure is relatively safe, prevents a high natural mortality, and offers a better chance of a faster recovery of left ventricular function.Anomalous origin ofthe left coronary artery from the pulmonary artery is a rare severe congenital anomaly that often causes myocardial infarction within a few weeks of birth with subsequent ventricular dysfunction, mitral valve incompetence, and severe congestive heart failure.There is disagreement about when to operate and whether prompt restoration of a systemic left coronary artery perfusion is important. There have been numerous conflicting reports about the risks of Requests for reprints to Professor Jean Kachaner, Hopital des Enfants-Malades,

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Surgical treatment of anomalous origin of the left coronary artery in infancy and childhood

Cited by 33 publications

References 11 publications

Does the degree of preoperative mitral regurgitation predict survival or the need for mitral valve repair or replacement in patients with anomalous origin of the left coronary artery from the pulmonary artery?

Does the degree of preoperative mitral regurgitation predict survival or the need for mitral valve repair or replacement in patients with anomalous origin of the left coronary artery from the pulmonary artery?

A long-term survivor of Bland-White-Garland syndrome with systemic collateral supply: A case report and review of the literature

Anomalous left coronary artery arising from the pulmonary artery in infancy: is early operation better?

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