The repair of anomaly left coronary artery from pulmonary artery: early and late outcome

  • Dr Katarzyna Ostrowska, Polish Mothers' Memorial Hospital, Lodz, Poland
  • Prof Jadwiga Moll, Polish Mothers' Memorial Hospital, Lodz, Poland
  • Dr Marek Kopala, Polish Mothers' Memorial Hospital, Lodz, Poland
  • Dr Pawel Dryzek, Polish Mothers' Memorial Hospital, Lodz, Poland
  • Prof Andrzej Sysa, Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lódz, Poland
  • Prof Jacek Moll, Department of Cardiosurgery, Polish Mother’s Memorial Hospital, Research Institute, Lódz, Poland

    • Background:
    Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) may lead to myocardial ischemia and infarction in children. LV and MV assessment are crucial in long-term follow-up. The aim of this study is to evaluate early and late outcome after operation for ALCAPA.
    Methods:
    Between September 1991 and April 2005, 27 children with ALCAPA were operated. Age at operation ranged from 2 months to 16 years (mean 29 months). Operative techniques included: the Takeuchi procedure with intrapulmonary tunnel (8 pts) and aortic reimplantation of LCA (19 pts). Postoperative follow-up ranged from 3 to 16 years and included: clinical examination, ECG, echocardiography, treadmill exercise testing, dobutamine stress echocardiography (DSE), myocardial scintigraphy (SPECT) and catheterization.
    Results:
    There were 5 postoperative deaths (hospital mortality- 18.5%; 4/8 pts operated by Takeuchi method (early experience) and 1/19 pts after aortic reimplantation) and no late deaths. Follow-up of surviving patients revealed no new ischemia, improved left ventricle function (LVEDd, LVEDV,EF,SF), decreased mitral regurgitation in most patients (moderate in 4 cases, mild - 8, trivial - 3), negative exercise testing (10/10 pts) and no changes of perfusion in stress myocardial scintigraphy in most cases (10/12 pts). DSE is performed in 14 pts (negative-8, positive - 2, non-diagnostic – 4); angiographic study demostrated non-stenotic left coronary artery (6/6 pts). Two patients required reoperation (1- supravalvular pulmonary stenosis, 1- mitral valve replacement).
    Conclusions:
    The direct aortic reimplantation of the anomalous left artery is preferred method of surgical
    treatment for ALCAPA with satisfactory long-term results