Introduction. Patients with anomalous origin of the left coronary artery from pulmonary artery (ALCAPA) have myocardial ischaemia resulting in left ventricular dysfunction. Both direct re-implantation and the tunnel procedure that are conventionally done require a period of global myocardial ischaemia.
Objective. To evaluate the outcome of patients with ALCAPA who underwent aortopulmonary tunnel (Takeuchi) repair on a beating heart in K K Women and Children’s Hospital.
Methods.
The hospital records of patients who underwent aortopulmonary tunnel (Takeuchi) repair on a beating heart for ALCAPA were retrospectively reviewed.
Results.
From October 2001 to March 2007 eight patients underwent Takeuchi repair on beating heart. The age ranges from 2 months to 24 months (median 3months), weight ranges from 3.9kg to 10.6Kg (median 5.49Kg,). Two patients were on ventilatory support prior to surgery. The cardiopulmonary bypass time ranges from 102 minutes to 228 minutes (median 149.5 minutes,). None of the patients were on assist device support post-operatively. There were no operative mortalities. Post-operative hospital stay ranges from 11 days to 38 days (mean 23.5 days, median 22 days). One patient had baffle leak and underwent correction 18 days after the first operation. On follow-up 2 patients had moderate pulmonary stenosis and underwent balloon dilatation 11 months and 24 months after the initial surgery respectively.
Conclusion. In critically ill patients surgical correction on a beating heart will reduce peri-operative myocardial injury, possibly reduce the need for temporary assist and improve outcomes.