Repair of Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA) beyond Infancy

Abstract

Between January 2002 and December 2012, five patients (4 female) underwent corrective surgery for anomalous left coronary artery from pulmonary artery (ALCAPA). They were older than 1 year (range, 3-56 years). One of the 2 patients younger than 10 years had presented with congestive heart failure, and the other had experienced repeated episodes of lower respiratory tract infection since childhood. Of the remaining 3 adult patients, 2 had experienced angina with effort, and 1 patient had had repeated respiratory tract infections since childhood, with mild dyspnea on effort of New York Heart Association (NYHA) class II. Three patients had the anomalous left coronary artery implanted directly into the ascending aorta via coronary-button transfer, and 2 patients underwent coronary artery bypass with obliteration of the left main ostium. Two patients underwent concomitant mitral valve repair procedures, and 1 patient underwent direct closure of a perimembranous ventricular septal defect. Four patients survived the surgery, and 1 patient died because of a persistently low cardiac output. Follow-up times ranged from 3 months to 4 years. All survivors are in NYHA class I and have left ventricular ejection fractions of 45% to 60%, with moderate (n = 1), mild (n = 1), or no (n = 2) mitral insufficiency. We conclude that a few naturally selected patients with ALCAPA do survive beyond infancy and can undergo establishment of 2 coronary systems with satisfactory results.

An Adult Case of Heart Failure due to Left Main Coronary Artery Atresia

“…Bland-White-Garland syndrome or ALCAPA syndrome (i.e., anomalous origin of the left coronary artery from the pulmonary artery) should be included in the differential diagnosis for LMCA atresia [ 8 , 9 ]. In the current case, no evidence suggesting the presence of the left coronary artery from the pulmonary artery was obtained on echocardiography focused on the pulmonary artery or cardiac CT.…”

An 8-Month-Old With a Chronic Cough

“…ALCAPA, also known as Bland−White−Garland syndrome, is a rare congenital cardiac anomaly affecting 1 in 300,000 live births (Talwar, Jha, Choudhary, Gupta, & Airan, 2013). In the normal heart, the left coronary artery originates from the aorta and supplies oxygen-rich blood to the muscles of the left side of the heart and the mitral valve.…”

Diagnosis and Surgical Outcomes of Patients with Anomalous Left Coronary Artery from the Pulmonary Artery: A Single Taiwanese Medical Center Experience

“…Although MR is common in patients with ALCAPA [Ramírez 2011;Ojala 2010;Alexi-Meskishvili 2011], repair or replacement of the mitral valve is a controversial procedure for ALCAPA correction [Talwar 2013]. The mechanisms of MR are usually multifactorial, including myocardial ischemia or infarction, papillary muscle dysfunction because of scarring and calcification, mitral ring dilatation with papillary muscle displacement, dyskinesia of the LV-free wall, and endocardial fibroelastosis involving the chordae tendineae, papillary muscles, and mitral leaflets [Ojala 2010;Azakie 2003].…”