Myocardial perfusion after aortic implantation for anomalous origin of the left coronary artery from the pulmonary artery

Abstract

Postoperative myocardial perfusion and function were evaluated using thallium-201 myocardial imaging and technetium-99m cardiac pool imaging in five patients with an anomalous left coronary artery arising from the pulmonary artery. The patients underwent reimplantation of the left coronary artery at an age ranging from 10 months to 13 years. Postoperative electrocardiographic and radionuclide studies were performed both at rest and during stress 1 to 4 years after the operation. Electrocardiograms which were abnormal preoperatively returned to normal after surgery except that the T wave in lead aVL remained negative. Postoperatively, left ventricular ejection fraction measured by technetium-99m cardiac pool imaging was normal in all patients. Postoperative thallium-201 myocardial imaging, however, showed a perfusion defect with incomplete redistribution at the high-lateral or antero-lateral segment in all patients after a stress test. These data suggest that although myocardial ischaemic change decreases and global cardiac function improves after establishment of a dual coronary artery system, severe myocardial damage remains at the high-lateral or antero-lateral segment.

Outcomes from anomalous origin of the left coronary artery from the pulmonary artery repair: Long-term complications in relation to residual myocardial abnormalities

“…These coronary findings were seen in our cases with adult-type ALCAPA. Several authors have reported that despite the improvement in or even the normalization of left ventricular function after surgical intervention, limitations associated with the myocardial blood flow or chronic myocardial injury can persist for years after surgery [12,14,15]. Left to right shunting from the RCA via the LCA to the PA, which is known as the coronary steal phenomenon, creates collateral vessels and coronary aneurysms or stenoses in patients with adult-type ALCAPA [16,17].…”

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

“…Late postrepair AR and residual significant mitral valve disease have both been reported. Chest pain, nuclear and positron emission tomography myocardial perfusion abnormalities, and decreased exercise performance have been noted after dual coronary artery repair and may correlate with residual patchy myocardial fibrosis from preoperative ischemia, as well as from residual proximal graft obstruction (473)(474)(475)(476). Proximal, midvessel, and even distal coronary artery obstructions, with coronary flow reserve abnormalities, have been noted and treated with intracoronary balloon dilations, stenting, radiotherapy, and reoperation (477)(478)(479)(480).…”

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

“…[473][474][475][476] Proximal, midvessel, and even distal coronary artery obstructions, with coronary flow reserve abnormalities, have been noted and treated with intracoronary balloon dilations, stenting, radiotherapy, and reoperation. [477][478][479][480] There has been no consistent correlation between long-term outcome and late symptoms, noninvasive ischemia and blood flow abnormality testing, residual coronary anatomic or flow abnormalities, or late interventions.…”