Early results of surgical correction of anomalous left coronary artery from pulmonary artery (ALCAPA)

  • Dr Samuel Ramirez-Marroquin, “Ignacio Chávez” National Cardiology Institute of Mexico, Mexico
  • Dr Jorge Cervantes, “Ignacio Chávez” National Cardiology Institute of Mexico, Mexico
  • Dr Pedro Curi-Curi, “Ignacio Chávez” National Cardiology Institute of Mexico, Mexico
  • Dr Juan Calderon-Colmenero, “Ignacio Chávez” National Cardiology Institute of Mexico
  • Dr Jaime Garcia, “Ignacio Chávez” National Cardiology Institute of Mexico, Mexico
  • Dr Emilia Patińo-Bahena, “Ignacio Chávez” National Cardiology Institute of Mexico, Mexico
  • Dr Jose Garcia-Montes, “Ignacio Chávez” National Cardiology Institute of Mexico, Mexico
  • Dr Alfonso Buendia, “Ignacio Chávez” National Cardiology Institute of Mexico, Mexico

    • Objective: To describe early and mid term results of surgical treatment of anomalous left coronary artery from pulmonary artery (ALCAPA).
    Methods: We studied retrospectively 11 patients (82% female) with mean age of 4.9 years that underwent surgical correction of ALCAPA with coronary implantation technique in a 17 year period.
    Results: Symptoms presented at a mean time of 12 months (range, 15 days to 6 years). Initial diagnosis of ALCAPA was made in 4 patients (33%) and the rest of them were admitted as mitral regurgitation (5), dilated myocardiopathy (2), or restrictive myocardiopathy (1). Mitral regurgitation presented in 83% of the cases, and was severe in 58%. Chest x-ray showed a congestion pattern in 66%, and cardiomegalia in all patients. Myocardial perfusion gammagraphy was performed in 8 cases and showed ischemia in all of them except one. Echocardiography in 25% of the patients had ejection fraction ≤ 30%. All patients were operated with coronary implantation technique, 3 cases had a concomitant mitral valve repair and one patient recquired a mitral valve replacement. There was no operative mortality. During the first postoperative day 75% of the cases were extubated. Mean time of ICU was 4 days and mean time for hospital discharge was 9.9 days.
    Conclusion: Dual-coronary system can be established in patients with ALCAPA by the coronary implantation technique with excellent early results. A careful clinical and echocardiographic analysis is recommended for the diagnosis of ALCAPA in all patients with cardiac failure due to mitral regurgitation or dilated myocardiopathy.