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

Abstract

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.

Acute myocardial infarction in the elderly with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA): A case report and literature review

“…Subclinical myocardial dysfunction can be identified early using more elaborate echocardiography. [10]…”

“…Medicine myocardial dysfunction can be identified early using more elaborate echocardiography. [10] In addition, when combined with single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI), left ventricular myocyte necrosis, injury, and functional ischemia can be identified early in asymptomatic adults. Chu et al performed SPECT MPI examination in an asymptomatic adult patient with ALCAPA.…”

Surgical management of anomalous origin of coronary artery from pulmonary artery

“…Despite good clinical condition and normalised LVEF (more than 55%) in ALCAPA patients after surgical repair in the long-term follow-up, the diastolic and longitudinal systolic function and LV torsion of all cardiac chambers remained impaired, especially in the LCA region. Lifelong surveillance is mandatory [ 22 , 23 ], as ischemia can lead to myocardial scarring, even in early infancy. The recovery of LV function is closely related to scar burden [ 24 ].…”

Left ventricular speckle tracking echocardiography in predicting of fibrosis in children after correction of anomalous origin of the left coronary artery from the pulmonary artery in the late postoperative period

“…Аномальное отхождение левой коронарной артерии от легочной артерии это крайне редкий врожденный порок сердца. Синдром АОЛКА -это уникальная клиническая модель для изучения влияния хронической гипоперфузии и последующей реперфузии на функцию ЛЖ без сопутствующих заболеваний, таких как гипертония, курение табака, диабет или дислипидемия [2][3][4]. Успешная реваскуляризация инициирует процесс обратного ремоделирования ЛЖ, но, несмотря на нормализацию общей функции ЛЖ после операции, могут существовать остаточные поражения коронарных артерий или фиброз.…”