Aortic Implantation for Anomalous Connection of the Coronary Artery to the Pulmonary Artery in Older Children and Adults

Abstract

Anomalous connection of the coronary artery to the pulmonary artery (ACAPA) has a low incidence rate in older children and adults. The aim of this article was to evaluate the outcome of treating ACAPA with aortic implantation in older children and adults. We included 21 patients (9 children and 12 adults) with ACAPA in our hospital between January 1991 and January 2015. Among these patients, 19 had anomalous connection of the left coronary artery to the pulmonary artery, 2 had anomalous connection of the right coronary artery to the pulmonary artery (ARCAPA). All of the patients underwent aortic implantation, aged 4 to 62 years (median, 18). The mean left ventricular ejection fraction (LVEF) was 55.9 ± 7.6% (<50% in 4). Eleven patients underwent direct aortic implantation (including two ARCAPAs), while 10 patients underwent tubular implantation. Eleven patients had varying degrees of mitral regurgitation, while mitral valve plasty or replacement was performed in six patients (severe mitral regurgitation) concurrently. There was no early mortality. Follow-up observation was performed in all 21 patients, with a mean follow-up time of 6.4 ± 5.6 years (ranging from 0.5 to 23 years). Two patients died due to noncardiac reasons 1 and 10 years after operation, respectively. Seven patients had mild mitral regurgitation, while no patients had moderate or severe mitral regurgitation after operations. The postoperative mean LVEF was not improved at 54.7 ± 7.0%, > 0.05. Among the multiple surgical strategies for the treatment of ACAPA, aortic implantation was used commonly in older children and adults, while mitral valve repair can be performed concurrently.

Anomalous origin of coronary arteries from the pulmonary artery: A single-center experience

“…An intervention to the mitral valve during the first surgery in patients who are symptomatic during infancy is usually not recommended, as postoperative ventricular remodeling and mitral regurgitation are likely to improve with reperfusion. [23,24] Kanoh et al [25] performed concomitant mitral annuloplasty in approximately 80% of ALCAPA patients with moderate-to-severe mitral insufficiency. In the present study, five ALCAPA patients needed mitral valve repair.…”

Repair of Anomalous Right Coronary Artery From the Pulmonary Artery Using the Modified Trapdoor Technique

“…Coronary steal from low pulmonary pressures causing right coronary artery (RCA) retrograde flow is the hallmark of ARCAPA. 5 The result is poor RCA territory perfusion with the development of extensive collateral networks that steal blood from the left coronary artery (LCA). The LCA dilates to accommodate the increased flow required by the collateralized network.…”

“…Multiple techniques can be used for implanting the RCA but not all address the difficulties encountered with ARCAPA. 5,6 Typically, the RCA is tortuous and thin-walled, which predisposes the RCA to kinking during transfer to the aorta. We have found that the use of a modified trapdoor technique in coronary transfer minimizes these concerns by creating more favorable RCA geometry following reimplantation.…”