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Outcomes of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children

Part of: Surgery

Published online by Cambridge University Press:  28 April 2021

Tong Feng Open the ORCID record for Tong Feng [Opens in a new window] ,
Guo Zhangke Open the ORCID record for Guo Zhangke [Opens in a new window] ,
Bai Song Open the ORCID record for Bai Song [Opens in a new window] ,
Fan Fan ,
Zhen Jia  and
Li Xiaofeng
Tong Feng
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
Guo Zhangke
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
Bai Song
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
Fan Fan
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
Zhen Jia
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
Li Xiaofeng*
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
*
Author for correspondence: Li Xiaofeng, Department of Cardiac Surgery, Beijing Children’s Hospital Affiliated to Capital Medical University, National Center for Children’s Health, 56 South Lishi Road, Xicheng District, Beijing, Beijing, 10045, China. Tel: +86 010 59616783. E-mail: [email protected]
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Abstract

Objectives:

Anomalous origin of the left coronary artery from the pulmonary artery is associated with high mortality if not timely surgery. We reviewed our experience with anomalous origin of the left coronary artery from the pulmonary artery to assess the preoperative variables predictive of outcome and post-operative recovery of left ventricular function.

Methods:

A retrospective review was conducted and collected data from patients who underwent anomalous origin of the left coronary artery from the pulmonary artery repair at our institute from April 2005 to December 2019. Left ventricular function was assessed by ejection fraction and the left ventricular end-diastolic dimension index. The outcomes of reimplantation repair were analysed.

Results:

A total of 30 consecutive patients underwent anomalous origin of the left coronary artery from the pulmonary artery repair, with a median age of 14.7 months (range, 1.5–59.6 months), including 14 females (46.67%). Surgery was performed with direct coronary reimplantation in 12 patients (40%) and the coronary lengthening technique in 18 (60%). Twelve patients had concomitant mitral annuloplasty. There were two in-hospital deaths (6.67%), no patients required mechanical support, and no late deaths occurred. Follow-up echocardiograms demonstrated significant improvement between the post-operative time point and the last follow-up in ejection fraction (49.43%±19.92% vs 60.21%±8.27%, p < 0.01) and in moderate or more severe mitral regurgitation (19/30 vs 5/28, p < 0.01). The left ventricular end-diastolic dimension index decreased from 101.91 ± 23.07 to 65.06 ± 12.82 (p < 0.01).

Conclusions:

Surgical repair of anomalous origin of the left coronary artery from the pulmonary artery has good mid-term results with low mortality and reintervention rates. The coronary lengthening technique has good operability and leads to excellent cardiac recovery. The decision to concomitantly correct mitral regurgitation should be flexible and be based on the pathological changes of the mitral valve and the degree of mitral regurgitation.

Keywords

Anomalous origin of the left coronary artery from the pulmonary arterysurgical treatmentpaediatricsleft ventricle
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 1 , January 2022 , pp. 36 - 41
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Hoffman, JI, Kaplan, S, Liberthson, RR Prevalence of congenital heart disease. Am Heart J 2004; 147: 425–439.CrossRefGoogle ScholarPubMed
Wesselhoeft, H, Fawcett, JS, Johnson, AL Anomalous origin of the left coronary artery from the pulmonary trunk: its clinical spectrum, pathology, and pathophysiology, based on review of 140 cases with seven further cases. Circulation 1968; 38: 403–25.CrossRefGoogle ScholarPubMed
Kakou-Guikahue, M, Sidi, D, Kachaner, J, et al. Anomalous left coronary artery arising from the pulmonary artery in infancy: is early operation better? Br Heart J 1988; 60: 522–526.CrossRefGoogle ScholarPubMed
Samuel, R, Curi-Curi, PJ, Calderón-Colmenero, J, et al. Outcomes of coronary reimplantation for correction of anomalous origin of left coronary artery from pulmonary artery. Rev Esp Cardiol 2011; 64: 681–687.Google Scholar
Belli, E, Roussin, R, Ly, M, et al. Anomalous origin of the left coronary artery from the pulmonary artery associated with severe left ventricular dysfunction: results in normothermia. Ann Thorac Surg 2010; 90: 856–860.CrossRefGoogle ScholarPubMed
Alsoufi, B, Sallehuddin, A, Bulbul, Z, et al. Surgical strategy to establish a dual-coronary system for the management of anomalous left coronary artery origin from the pulmonary artery. Ann Thorac Surg, 2008; 86: 170–176.CrossRefGoogle ScholarPubMed
Monge, MC, Eltayeb, O, Costello, JM, et al. Aortic implantation of anomalous origin of the left coronary artery from the pulmonary artery: long-term outcomes. Ann Thorac Surg 2015; 100: 154–161.CrossRefGoogle ScholarPubMed
Dodge-Khatami, A, Mavroudis, C, Backer, CL Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 2002; 74: 946–955.CrossRefGoogle ScholarPubMed
Straka, N, Gauvreau, K, Allan, C, et al. Factors associated with adverse outcomes after repair of anomalous coronary from pulmonary artery. Ann Thorac Surg 2019; 108: 785–791.CrossRefGoogle ScholarPubMed
Khanna, A, Torigian, D, Ferrari, V, Bross, R, Rosen, M Anomalous origin of the left coronary artery from the pulmonary artery in adulthood on CT and MRI. Am J Roentgenol 2005; 185: 326–329.CrossRefGoogle ScholarPubMed
Naimo, PS, Fricke, TA, d’Udekem, Y, et al. Surgical intervention for anomalous origin of left coronary artery from the pulmonary artery in children: a long-term follow-up. Ann Thorac Surg 2016; 101: 1842–1848.CrossRefGoogle ScholarPubMed
Kudumula, V, Mehta, C, Stumper, O, et al. Twenty-year outcome of anomalous origin of left coronary artery from pulmonary artery: management of mitral regurgitation. Ann Thorac Surg 2014; 97: 938–944.CrossRefGoogle ScholarPubMed
Alexi-Meskishvili, V, Nasseri, BA, Nordmeyer, S, et al. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children. J Thorac Cardiovasc Surg 2011; 142: 868–874.CrossRefGoogle ScholarPubMed
Azakie, A, Russell, JL, McCrindle, BW, et al. Anatomic repair of anomalous left coronary artery from the pulmonary artery by aortic reimplantation: early survival, patterns of ventricular recovery and late outcome. Ann Thorac Surg 2003; 75: 1535–1541.CrossRefGoogle ScholarPubMed
Qiu, J, Li, S, Yan, J, et al. Repair of anomalous coronary artery from the pulmonary artery: a-signal center 20-year experience. Int J Cardiol 2016; 223: 625–629.CrossRefGoogle ScholarPubMed
Schmitt, B, Bauer, S, Kutty, S, et al. Myocardial perfusion, scarring, and function in anomalous left coronary artery from the pulmonary artery syndrome: a long-term analysis using magnetic resonance imaging. Ann Thorac Surg 2014; 98: 1425–1436.CrossRefGoogle ScholarPubMed
Fudulu, DP, Dorobantu, DM, Azar Sharabiani, MT, et al. Outcomes following repair of anomalous coronary artery from the pulmonary artery in infants: results from a procedure-based national database. Open Heart 2015; 2: e000277.CrossRefGoogle ScholarPubMed