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

Kim, Young-su; Lee, Mina; Cho, Yang Hyun; Yang, Ji-Hyuk; Jun, Tae-Gook

doi:10.5090/kjtcs.2014.47.3.220

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…We never had any injury to aortic valve leaflet or the commissure. Although we have only two adult ALCAPA in our series, we believe that the direct transfer of coronary artery is possible in adult patients using in situ lateral or medial base trap door technique or by using native tissue for coronary artery reconstruction [ 8 ]. Small dose of cardioplegia was given to check for any bleeding from anastomotic site or from any collateral vessel.…”

Section: Methodsmentioning

confidence: 99%

Surgical management of anomalous origin of coronary artery from pulmonary artery

Mishra

2021

Indian J Thorac Cardiovasc Surg

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Background Anomalous origin of coronary artery from pulmonary artery (AOCAPA), as is evident from the name, is defined as abnormal origin of either coronary artery from the pulmonary artery. The consequences vary in most cases and these anomalies lead to severe coronary hypo-perfusion and ventricular dysfunction. The common variants of this cardiac malformation are an anomalous origin of a left coronary artery from a pulmonary artery (ALCAPA) and anomalous origin of the right coronary artery from a pulmonary artery (ARCAPA). Another rare variant is left main coronary artery atresia that resembles ALCAPA in its mode of presentation. This article presents a single surgeon experience of managing this complex subset of the coronary anomaly from April 2006 to July 2019. Material and methods The 105 patients, who underwent surgery for AOCAPA from April 2006 to July 2019, have been included in the study. The patients have been analysed by follow-up echocardiography and electrocardiography (ECG) at our hospital by paediatric cardiologists. Out of 105 patients of AOCAPA, 98 (93.3%) patients underwent ALCAPA repair, of which 59 (60.2%) were males and 39 (39.7%) were females. Four out of five patients, who had an anomalous origin of the left coronary artery from the right pulmonary artery (ALCARPA), had an intramural aortic course. Three patients (3%) had left main coronary artery atresia and four patients (4%) had ARCAPA. It may be mentioned that seven infants (7.14%) and one adult patient (1%) underwent concomitant mitral valve repair. All the patients with ALCAPA, left main coronary artery atresia and ARCAPA, and 1 of the patients with ALCARPA, underwent coronary relocation. In four out of five patients with ALCARPA, unroofing of intraaortic intramural course was performed. Results Out of 105 patients of AOCAPA, 9 (8.5%) patients had in-hospital mortality. Five infants (5.0%) with ALCAPA and one patient (1%) with ALCARPA died in the post-operative period due to severe left ventricular dysfunction, mitral regurgitation (MR) and sepsis. One adult patient (1%) with ALCAPA, who underwent coronary relocation using in situ trap door technique and mitral valve (MV) repair, died due to massive intracranial bleeding. Two patients out of three (66.6%) with left main coronary atresia died in intensive care unit (ICU) after 3rd and 4th postoperative day, due to low cardiac output, severe ventricular dysfunction and severe MR. Patients were followed up for a median 5.9 years. Seven patients were lost to follow-up, including the sole survivor of left main coronary atresia, after a median follow-up of 4 years after surgery. Three patients underwent mitral valve replacement for progressive residual MR. There has been no late mortality. Conclusion AOCAPA is a rare congenital cardiac anomaly, which usually presents in infancy with left ventricular dysfunction and mitral valve regurgitation. Early diagnosis and surgical re-establishment of the dual coronary system has given gratifying results, with improvement in left ventricular function ...

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Section: Methodsmentioning

confidence: 99%

Surgical management of anomalous origin of coronary artery from pulmonary artery

Mishra

2021

Indian J Thorac Cardiovasc Surg

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“…The two-flap technique requires harvesting the anomalous left coronary artery with a pulmonary artery flap. Subsequently, an aortic wall flap is created, and the two flaps are sutured together to lengthen the left coronary artery, producing tension-free anastomosis (Figure 7) [21].…”

Section: Treatmentmentioning

confidence: 99%

Anomalous Left Coronary Artery from the Pulmonary Artery: How to Diagnose and Treat

Blickenstaff,

Smith,

Cetta

et al. 2023

JPM

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Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary anomaly that can present in childhood or adulthood with a multitude of symptoms depending on the age of presentation. It should be suspected in infants presenting with heart failure in the setting of left ventricular systolic dysfunction and associated mitral regurgitation from papillary muscle ischemia. Adults with ALCAPA may present with cardiac ischemic symptoms. Prompt diagnosis with echocardiography and cross-sectional chest imaging is important to guide surgical intervention and improve the patients’ survival and prognosis. The goal of surgery is to establish a dual-coronary system with mid-term results revealing progressive recovery of left ventricular function and improvement in mitral regurgitation. Patients with ALCAPA should maintain life-long follow-up with a cardiologist with congenital heart disease expertise for surveillance of post-operative complications.

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Off-pump surgical correction of abnormal discharge of the right coronary artery from the pulmonary trunk

Ivanov¹,

Гуреев²,

Glamazda³

et al. 2016

Kardiol. serdechno-sosud. khir.

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Синдром Бланда-Уайта-Гарланда (СБУГ) -врож-денная аномалия коронарного русла, характеризующаяся отхождением коронарных артерий (КА) от легочной арте-рии (ЛА), вследствие чего значительный участок миокар-да не получает адекватного артериального кровоснабже-ния.В литературе описано несколько вариантов отхожде-ния одной из КА от легочного ствола. Наиболее часто встречается аномальное отхождение левой КА, которое составляет около 90% от числа всех остальных вариантов. Как правило, левая КА отходит от левого или заднего си-нуса легочного ствола. Значительно реже встречается от-хождение правой артерии (10%), а также обеих КА. Опи-саны единичные случаи изолированного отхождения пе-редней нисходящей, огибающей, конусной артерий от ЛА при отхождении стволов двух артерий от аорты.Порок впервые описан J. Brooks в 1886 г. как случай-ная находка при вскрытии двух взрослых людей, при жиз-ни не страдавших заболеваниями сердца [4,9]. В 1911 г. особенности анатомии венечных сосудов при данной па-тологии подробно исследовал А.И. Абрикосов. В 1933 г. американские кардиологи Е. Бланд (Edward Franklin Bland), П. Уайт (Paul Dudley White) и Й. Гарланд (Joseph Garland) подробно описали клинические и электрокардио-графические ЭКГ-признаки данной аномалии, за что дан-ный синдром назвали в их честь [4,7,9]. Последующие описания порока были также только случайными наход-ками при операциях по поводу сопутствующих пороков. В 1973 г. F. Gerbode и D. Radeliff впервые продемонстри-

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

Cited by 3 publications

References 18 publications

Surgical management of anomalous origin of coronary artery from pulmonary artery

Surgical management of anomalous origin of coronary artery from pulmonary artery

Anomalous Left Coronary Artery from the Pulmonary Artery: How to Diagnose and Treat

Off-pump surgical correction of abnormal discharge of the right coronary artery from the pulmonary trunk

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