Surgical outcomes for anomalous left coronary artery from the pulmonary artery: Influence of late presentation

Zhang, Wen; Hu, Renjie; Zhu, Yifan; Zhang, Weituo; Yu, Xiafeng; Sun, Yanjun; Zhu, Hongbin; Zhang, Haibo

doi:10.1016/j.jtcvs.2019.09.179

Cited by 13 publications

(7 citation statements)

References 30 publications

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“…In contrast to the series reported by Monge et al [25], we never came across any patient who underwent surgery in late infancy and had normal LV function during follow-up. Probably this is because of late diagnosis and delayed presentation in developing countries, like ours [18]. However, most of our patients showed gradual improvement in LV function and symptomatic improvement on after-load reducing medicines.…”

Section: Left Ventricular Functionmentioning

confidence: 61%

“…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: 72%

“…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: 77%

“…Severe MR leads to prolonged ventilation and it is extremely tough weaning from the ventilator. So, since 2012, we electively repair MV in patients with moderate to severe MR using posterior suture annuloplasty [18,20,26]. We have observed that in the patients, who underwent MV repair for severe MR, even if there was residual mild to moderate MR, their post-operative course in ICU was smooth.…”

Section: Mitral Regurgitationmentioning

confidence: 99%

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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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Section: Left Ventricular Functionmentioning

confidence: 61%

“…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: 72%

Section: Mitral Regurgitationmentioning

confidence: 77%

Section: Mitral Regurgitationmentioning

confidence: 99%

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Surgical management of anomalous origin of coronary artery from pulmonary artery

Mishra

2021

Indian J Thorac Cardiovasc Surg

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“…The advent of multidetector computed tomography (CT) angiography, with its multiplanar reconstructive capabilities and volume rendering techniques, has mitigated many of these challenges and has led to better preoperative identification of this crucial coronary anomaly. While there have been anecdotal case reports and surgical series published on the subject, a comprehensive imaging‐based series on ALCAPA using multidetector CT angiography is lacking in literature 11–13 . The present study sought to describe the morphological characteristics and imaging features of ALCAPA as identified on dual‐source multidetector CT angiography.…”

Section: Introductionmentioning

confidence: 99%

Anomalous origin of left main coronary artery from pulmonary artery: Patient characteristics and imaging associations on multidetector computed tomography angiography

Ojha

Pandey

Kumar

et al. 2021

Journal of Cardiac Surgery

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Aim To evaluate the various imaging features and associations on multidetector computed tomography (CT) angiography in patients with anomalous origin of left main coronary artery (LMCA) from pulmonary artery (ALCAPA). Materials and Methods We retrospectively reviewed multidetector CT angiography studies done for the evaluation of congenital heart diseases at our institution through 2014 to 2021. Cases with ALCAPA were identified and relevant history and imaging findings including the origin of coronary arteries, left ventricular (LV) morphology and functions, intercoronary collaterals, and associated abnormalities were evaluated. Results Twelve patients (eight males, three adults, and nine children; age range: 2 months to 54 years) with ALCAPA were included. Gradually progressive dyspnea and failure to thrive (6/9; 66.67% each) were the most common symptoms among children, whereas adults were commonly asymptomatic (2/3; 66.67%). The LMCA was originating from pulmonary sinus, main, and right pulmonary artery in 6 (50%), 5 (41.66%), and 1 (8.3%) patients, respectively. In adult‐type ALCAPA, right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCx) were dilated and tortuous, with the presence of well‐developed intercoronary collaterals and preserved LV ejection fractions; these features were not seen in patients of infantile ALCAPA. LV dysfunction with global hypokinesia was the most common wall motion abnormality (7/12; 58.33%). Conclusion Degree of collateralization could be the key factor determining the time of presentation, clinical symptoms, and LV function, thus influencing clinical outcomes. Patients with infantile ALCAPA present with features of heart failure and have dilated and dysfunctional LV consequent to lack of collaterals, unlike adult‐type ALCAPA.

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Coronary Artery Anomalies

Mavroudis

Dodge‐Khatami

Backer

2023

Pediatric Cardiac Surgery

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Surgical outcomes for anomalous left coronary artery from the pulmonary artery: Influence of late presentation

Cited by 13 publications

References 30 publications

Surgical management of anomalous origin of coronary artery from pulmonary artery

Surgical management of anomalous origin of coronary artery from pulmonary artery

Anomalous origin of left main coronary artery from pulmonary artery: Patient characteristics and imaging associations on multidetector computed tomography angiography

Coronary Artery Anomalies

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