Left Ventricular Mechanics in Patients with Abnormal Origin of the Left Main Coronary Artery from the Pulmonary Trunk Late after Successful Repair

Salvo, Giovanni Di; Siblini, Ghassan; Issa, Ziad F.; Mohammed, Habdan; Hazeem, Anas Abu; Pergola, Valeria; Muhanna, Nisreen; Qweai, Naif Al; Galzerano, Domenico; Fadel, Bahaa M.; Fayyadh, Majid Al; Joufan, Mansour; Halees, Zohair Al; Bulbul, Ziad

doi:10.1159/000447961

Cited by 19 publications

(14 citation statements)

References 33 publications

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“…In the study by Secinaro et al [31] performed with the use of the cardiac magnetic resonance imaging in 6 patients aged 6–21 years, the abnormalities were localized in the LV antero-lateral wall. In our study, the impaired LS was located predominantly in the LV postero-lateral wall, however in contrast to other studies [9,11, 30] regional abnormalities were present also in the RCA region. Additionally, some authors [16, 31] observed sparing of the apical segments after ALCAPA repair, while patients in our study showed akinetic apical segments and severely abnormal LS in this region.…”

Section: Discussioncontrasting

confidence: 99%

“…Mertens et al reported on the utility of serial strain measurements in an infant after ALCAPA repair, in who after the surgery the recovery of longitudinal function was delayed when compared with radial function [29]. Similarly, Di Salvo et al [30] showed persistent abnormal longitudinal myocardial strain in 30 patients assessed at least 12 months after ALCAPA repair. In contrast, Cabrera et al [9] showed decreased both: global longitudinal and circumferential strain in 11 out of 14 ALCAPA patients (79%) examined at (median) 6 years after surgical repair.…”

Section: Discussionmentioning

confidence: 99%

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Myocardial function in patients with anomalous left coronary artery from the pulmonary artery syndrome: A long-term speckle tracking echocardiographic study

et al. 2019

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BackgroundAnomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare congenital heart disease. Retrograde flow from the right coronary artery (RCA) through natural collaterals to the low-pressure main pulmonary artery causes extensive ischemia. Limited data concerning the extent of permanent myocardial damage and functional recovery after surgical repair in the long-term follow-up is available.AimDetermination of the incidence of incipient myocardial dysfunction in ALCAPA patients in the long-term observation using tissue Doppler and speckle tracking echocardiography.Methods and resultsEighteen ALCAPA patients after surgical repair (at median age of 7 months, range 3–167) underwent echocardiographic examination after (median) 17 years. All but 4 patients in NYHA class II presented well at follow-up. No narrowing in proximal LCA was detected in color Doppler. The initial (pre-surgical) left ventricular (LV) ejection fraction of 33±17% almost normalized to 55±6%, but was lower than in the age, sex and body surface area matched control group: 62±5% (p<0.001). At follow-up, LV global longitudinal strain (LS): -15.8±3.3% vs -21.9±1.7%; right ventricular LS: -20.6±3.9% vs -24.9±4.6%; left atrial LS: 27.7±4.3% vs 41.0±11.5%; right atrial LS: 26.8±7.4% vs 44.0±7.9% and early pulsed wave to tissue Doppler mitral filling ratio (E/E’): 8.1±2.6 vs 5.8±1.3 were impaired in the ALCAPA population in comparison to the control group (p<0.01 for all comparisons). LV radial and circumferential strain did not differ between groups. Mean LS in the ALCAPA patients in the RCA region was -19.0±4.4%, while in the LCA region -13.8±7.3% (p<0.00001).ConclusionsDespite good clinical condition and normalized LV ejection fraction in ALCAPA patients after surgical repair in the long-term follow-up, the diastolic and longitudinal systolic function of all cardiac chambers remained impaired, especially in the LCA region. Lifelong surveillance of repaired ALCAPA patients is needed.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Myocardial function in patients with anomalous left coronary artery from the pulmonary artery syndrome: A long-term speckle tracking echocardiographic study

et al. 2019

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“…In our series, ALCAPA was present in 0.42% of patients while in the largest series of CAAs, ALCAPA was present in 0.95% [13]. These patients often have an impaired cardiovascular mechanics with one of the studies reporting impaired left ventricular (LV) longitudinal deformation and LV torsion along with diastolic dysfunction following surgery in asymptomatic ALCAPA with normal global systolic function (LVEF >50%) [20].…”

Section: Discussionmentioning

confidence: 55%

Prevalence and patterns of coronary artery anomalies in 28,800 adult patients undergoing angiography in a large tertiary care centre in India

Bansal

Sarkar

Gupta

et al. 2021

Monaldi Arch Chest Dis

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Coronary artery anomalies (CAAs) are a diverse group of disorders with varied clinical presentation and pathophysiological mechanisms. A majority of these anomalies are asymptomatic and often an incidental finding on coronary angiogram or autopsy. This retrospective study included 28,800 patients who underwent coronary angiography from 2016 to 2020. The coronary angiograms were reviewed by two independent reviewers and CAAs were documented. CAAs were classified into (a) anomalies of coronary artery connection, (b) anomalies of intrinsic coronary arterial anatomy and (c) anomalies of myocardial/coronary artery interaction as proposed by the European Society of Cardiology. Of the 28,800 coronary angiograms, CAAs were present in 4.12% with anomalies in the left coronary artery (LCA) being most common. Anomalies of coronary artery connection were most common (48.48%) followed by anomalies of myocardial/coronary artery interaction (34.49%) and anomalies of intrinsic coronary artery anatomy (17.03%). Among anomalies of coronary artery connection, absent left main trunk or split LCA with separate origins of left anterior descending coronary artery and left circumflex coronary artery from the left coronary sinus of Valsalva (22.59%) was most common. An intramural course or “myocardial bridge” had an incidence of 1.16% while incidence of coronary artery fistulae (CAF) was 0.115%.

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“…LV dysfunction has been reported as the main risk factor for perioperative mortality [18,19]. We have observed that there is the minimal improvement in LVEF on the day of surgery.…”

Section: Left Ventricular Functionmentioning

confidence: 73%

“…Medical practitioners generally believe that with the improvement of LV function and dimensions after successful revascularisation, the mitral annular size shall decrease with subsequent improvement in MR. However, our experience does not corroborate this view point, and for patients who come in late infancy and childhood with severe MR, where the cause of MR is ischemic lesions of the papillary muscle (organic MR), we recommend MV repair [18,19]. In this group, mitral annuloplasty in association with coronary reimplantation is indicated due to the reduced likelihood of regression of MR after coronary revascularisation [26].…”

Section: Mitral Regurgitationmentioning

confidence: 82%

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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Left Ventricular Mechanics in Patients with Abnormal Origin of the Left Main Coronary Artery from the Pulmonary Trunk Late after Successful Repair

Cited by 19 publications

References 33 publications

Myocardial function in patients with anomalous left coronary artery from the pulmonary artery syndrome: A long-term speckle tracking echocardiographic study

Myocardial function in patients with anomalous left coronary artery from the pulmonary artery syndrome: A long-term speckle tracking echocardiographic study

Prevalence and patterns of coronary artery anomalies in 28,800 adult patients undergoing angiography in a large tertiary care centre in India

Surgical management of anomalous origin of coronary artery from pulmonary artery

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