Anomalous left coronary artery from the pulmonary artery repair outcomes: Preoperative mitral regurgitation persists in the follow‐up

Abstract

Objective: This study aims to present the midterm outcomes of surgical correction of the anomalous left coronary artery from the pulmonary artery (ALCAPA) with a focus on mitral regurgitation (MR). Methods: Medical records of 36 ALCAPA patients who underwent surgery in a single center were retrospectively reviewed. Results: There were one (2.7%) neonate, 19 (52.7%) infants, 15 (41.6%) children, and 1 (2.7%) adult patient operated. Coronary reimplantation, tube reconstruction, and coronary artery bypass surgery techniques were performed in 29 (80.5%), 6 (16.6%), and 1 (2.7%) patient, respectively. Sixteen (44.4%) patients had a low ejection fraction and 13 (36.1%) patients had at least moderate MR preoperatively. None of our patients underwent a concomitant mitral surgery during the initial repair. Three and two patients died in the early and late postoperative period, respectively. Two patients underwent reoperation due to MR and pulmonary stenosis, separately. Preoperative MR was the only factor associated with at least moderate MR at the final follow-up (p < .01) and the presence of preoperative moderate or over-moderate MR estimated at least moderate MR at the final follow-up with 100% sensitivity and 80% specificity. Conclusion: Although the mitral valve was not repaired in the first operation, the reoperation rate is low. However, a moderate or higher preoperative MR predicted MR at the last follow-up. Performing annuloplasty in such patients can be a strategy to be researched.

Anomalous left coronary artery from the pulmonary artery: Outcomes and management of mitral valve

“…Brown et al ( 3 ) argued that concurrent mitral valve intervention is unnecessary for patients with ALCAPA. However, Biçer et al ( 4 ) noted that despite the low rate of mitral valve reintervention, more than moderate preoperative MR required attention. Similarly, Weixler et al ( 5 ) believed that patients with more than moderate MR had a higher risk of reintervention after surgery.…”

Anomalous left coronary artery from pulmonary artery repair: Outcomes from the European Congenital Heart Surgeons Association Database

“…Alsoufi et al22 and more recently Weixler et al20 recommended concomitant MV repair in patients with severe MVI or in whom preoperative organic, rather than functional, MV pathology is diagnosed. In older children with important MVI, MV repair at the time of coronary reimplantation may be advisable because, unlike in infants, the cause of MVI could be irreversible myocardial or papillary damage, which is not expected to improve with recovery of left ventricular function 23. Lastly, Huddleston et al3 recommended cardiac catheterization in patients with recurrent or persistent MVI after ALCAPA repair, to evaluate the patency of the reimplanted coronary artery before MV repair.…”