Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-24T12:02:28.191Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgery and critical care for anomalous coronary artery from the pulmonary artery

Published online by Cambridge University Press:  01 December 2010

Timothy A. Fehrenbacher ,
Michael E. Mitchell ,
Nancy S. Ghanayem  and
James S. Tweddell
Timothy A. Fehrenbacher
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery and the Section of Critical Care, Department of Pediatrics, Herma Heart Center, Children’s Hospital of Wisconsin, the Medical College of Wisconsin, Wisconsin, United States of America
Michael E. Mitchell
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery and the Section of Critical Care, Department of Pediatrics, Herma Heart Center, Children’s Hospital of Wisconsin, the Medical College of Wisconsin, Wisconsin, United States of America
Nancy S. Ghanayem
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery and the Section of Critical Care, Department of Pediatrics, Herma Heart Center, Children’s Hospital of Wisconsin, the Medical College of Wisconsin, Wisconsin, United States of America
James S. Tweddell*
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery and the Section of Critical Care, Department of Pediatrics, Herma Heart Center, Children’s Hospital of Wisconsin, the Medical College of Wisconsin, Wisconsin, United States of America
*
Correspondence to: J. S. Tweddell, MD, Children’s Hospital of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, Wisconsin 53226, United States of America. Tel: 414 266 2638; Fax: 414 266 2075; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital cardiac malformation that accounts for 0.25–0.50% of children with congenital cardiac disease and can cause myocardial dysfunction in young infants. In any infant presenting with ventricular dysfunction, the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery must be suspected and the origin of the coronary arteries must be confirmed. The diagnosis of anomalous origin of the left coronary artery from the pulmonary artery is an indication for surgical repair. A two-coronary arterial system is the goal and is almost always achievable. The goal of surgical therapy is the creation of a two-coronary arterial system, which appears to provide better long-term survival and protection from left ventricular dysfunction and mitral valvar regurgitation than does simple ligation of the anomalous coronary artery. Direct reimplantation of the anomalous coronary artery is the procedure of choice. It is straightforward and borrows from well-practised techniques commonly used in other procedures such as the arterial switch operation. For the rare patient in whom direct reimplantation is not possible, strategies to lengthen the anomalous coronary artery, or baffle it within the pulmonary root, are available. Mitral valvar regurgitation is common at presentation, but following the establishment of a two-coronary arterial system and satisfactory myocardial perfusion, regurgitation of the mitral valve resolves in the vast majority. Therefore, mitral valvuloplasty at the time of initial surgery for anomalous origin of the left coronary artery from the pulmonary artery is not indicated. Post-operative care requires careful manipulation of inotropic support and reduction of afterload. Mechanical support, with either extracorporeal membrane oxygenation or left ventricular assist device, should be available for use if necessary.

Keywords

Congenital cardiac diseasepaediatric cardiac diseaseALCAPAanomalous origin of the left coronary artery from the pulmonary artery
Type
Original Article
Information
Cardiology in the Young , Volume 20 , Issue S3: Rare and Challenging Congenital Cardiac Lesions: an Interdisciplinary Approach , December 2010 , pp. 35 - 43
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Ojala, T, Salminen, J, Happonen, JM, Pihkala, J, Jokinen, E, Sairanen, H. Excellent functional result in children after correction of anomalous origin of left coronary artery from the pulmonary artery--a population-based complete follow-up study. Interact Cardiovasc Thorac Surg 2010; 10: 70–75.CrossRefGoogle ScholarPubMed
2.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
3.Backer, CL, Stout, MJ, Zales, VR, et al. Anomalous origin of the left coronary artery. A twenty-year review of surgical management. J Thorac Cardiovasc Surg 1992; 103: 1049–1057; discussion 57–58.CrossRefGoogle ScholarPubMed
4.Brooks, SJ. Two cases of abnormal coronary artery of the heart arising from the pulmonary artery: with some remarks upon the effect of this anomaly in producing cirsoid dilation of the vessels. J Anat Physiol 1886; 20: 26–32.Google Scholar
5.Bland, EF, White, PD, Garland, J. Congenital anomalies of the coronary arteries: report of an unusual case associated with cardiac hypertrophy. Am Heart J 1933; 8: 787–801.CrossRefGoogle Scholar
6.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 a review of 140 cases with seven further cases. Circulation 1968; 38: 403–425.CrossRefGoogle ScholarPubMed
7.Arciniegas, E, Farooki, ZQ, Hakimi, M, Green, EW. Management of anomalous left coronary artery from the pulmonary artery. Circulation 1980; 62 (Part 2): I180–I189.Google ScholarPubMed
8.George, JM, Knowlan, DM. Anomalous origin of the left coronary artery from the pulmonary artery in an adult. N Engl J Med 1959; 261: 993–998.CrossRefGoogle ScholarPubMed
9.Bunton, R, Jonas, RA, Lang, P, Rein, AJ, Castaneda, AR. Anomalous origin of left coronary artery from pulmonary artery. Ligation versus establishment of a two coronary artery system. J Thorac Cardiovasc Surg 1987; 93: 103–108.CrossRefGoogle ScholarPubMed
10.Birk, E, Stamler, A, Katz, J, et al. Anomalous origin of the left coronary artery from the pulmonary artery: diagnosis and postoperative follow up. Isr Med Assoc J 2000; 2: 111–114.Google ScholarPubMed
11.Moodie, DS, Fyfe, D, Gill, CC, et al. Anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome) in adult patients: long-term follow-up after surgery. Am Heart J 1983; 106: 381–388.CrossRefGoogle ScholarPubMed
12.Berdjis, F, Takahashi, M, Wells, WJ, Stiles, QR, Lindesmith, GG. Anomalous left coronary artery from the pulmonary artery. Significance of intercoronary collaterals. J Thorac Cardiovasc Surg 1994; 108: 17–20.CrossRefGoogle ScholarPubMed
13.Alexi-Meskishvili, V, Berger, F, Weng, Y, Lange, PE, Hetzer, R. Anomalous origin of the left coronary artery from the pulmonary artery in adults. J Card Surg 1995; 10 (Part 1): 309–315.CrossRefGoogle ScholarPubMed
14.Fernandes, ED, Kadivar, H, Hallman, GL, Reul, GJ, Ott, DA, Cooley, DA. Congenital malformations of the coronary arteries: the Texas Heart Institute experience. Ann Thorac Surg 1992; 54: 732–740.CrossRefGoogle ScholarPubMed
15.Edwards, JE. The direction of blood flow in coronary arteries arising from the pulmonary trunk. Circulation 1964; 29: 163–166.CrossRefGoogle ScholarPubMed
16.Nichols, DG, Ungerleider, RM, Spevak, PJ, et al. Anomalous left coronary artery. In: Nichols DG, Ungerleider RM, Spevak PJ, Greeley WJ, Cameron DE, Lappe DG and Wetzel RC (eds.). Critical Heart Disease in Infants and Children. Mosby, Philadelphia, 2006, pp 675–685.Google Scholar
17.Takimura, CK, Nakamoto, A, Hotta, VT, Campos, MF, Malamo, M, Otsubo, R. Anomalous origin of the left coronary artery from the pulmonary artery: report of an adult case. Arq Bras Cardiol 2002; 78: 309–314.CrossRefGoogle ScholarPubMed
18.Brown, JW, Ruzmetov, M, Parent, JJ, Rodefeld, MD, Turrentine, MW. Does the degree of preoperative mitral regurgitation predict survival or the need for mitral valve repair or replacement in patients with anomalous origin of the left coronary artery from the pulmonary artery? J Thorac Cardiovasc Surg 2008; 136: 743–748.CrossRefGoogle ScholarPubMed
19.Agustsson, MH, Gasul, BM, Fell, EH, Graettinger, JS, Bicoff, JP, Waterman, DF. Anomalus origin of left coronary artery from pulmonary artery. JAMA 1962; 180: 15–21.CrossRefGoogle ScholarPubMed
20.Raisky, O, Roubertie, F, Ali, WB, Vouhe, PR. Anomalous origin of the left coronary artery from the pulmonary artery: surgical treatment. Mulitmedia Manual of Cardiothoracic Surgery 2008: 1–7.Google ScholarPubMed
21.Frommelt, MA, Miller, E, Williamson, J, Bergstrom, S. Detection of septal coronary collaterals by color flow Doppler mapping is a marker for anomalous origin of a coronary artery from the pulmonary artery. J Am Soc Echocardiogr 2002; 15: 259–263.CrossRefGoogle ScholarPubMed
22.Kittle, CF, Diehl, AM, Heilbrunn, A. Anomalous left coronary artery arising from the pulmonary artery; report of a case and surgical consideration. J Pediatr 1955; 47: 198–206.CrossRefGoogle ScholarPubMed
23.Mustard, WT. Anomalies of the coronary artery. In: Welch KJ (ed.). Pediatric Surgery. Year Book, Chicago, 1962, p 433.Google Scholar
24.Case, RB, Morrow, AG, Stainsby, W, Nestor, JO. Anomalous origin of the left coronary artery; the physiologic defect and suggested surgical treatment. Circulation 1958; 17: 1062–1068.CrossRefGoogle ScholarPubMed
25.Sabiston, DC Jr, Neill, CA, Taussig, HB. The direction of blood flow in anomalous left coronary artery arising from the pulmonary artery. Circulation 1960; 22: 591–597.CrossRefGoogle ScholarPubMed
26.Cooley, DA, Hallman, GL, Bloodwell, RD. Definitive surgical treatment of anomalous origin of left coronary artery from pulmonary artery: indications and results. J Thorac Cardiovasc Surg 1966; 52: 798–808.CrossRefGoogle Scholar
27.Meyer, BW, Stefanik, G, Stiles, QR, Lindesmith, GG, Jones, JC. A method of definitive surgical treatment of anomalous origin of left coronary artery. A case report. J Thorac Cardiovasc Surg 1968; 56: 104–107.CrossRefGoogle ScholarPubMed
28.Neches, WH, Mathews, RA, Park, SC, et al. Anomalous origin of the left coronary artery from the pulmonary artery. A new method of surgical repair. Circulation 1974; 50: 582–587.CrossRefGoogle ScholarPubMed
29.Takeuchi, S, Imamura, H, Katsumoto, K, et al. New surgical method for repair of anomalous left coronary artery from pulmonary artery. J Thorac Cardiovasc Surg 1979; 78: 7–11.CrossRefGoogle ScholarPubMed
30.Turley, K, Szarnicki, RJ, Flachsbart, KD, Richter, RC, Popper, RW, Tarnoff, H. Aortic implantation is possible in all cases of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 1995; 60: 84–89.CrossRefGoogle ScholarPubMed
31.Kececioglu, D, Voth, E, Morguet, A, Munz, DL, Vogt, J. Myocardial ischemia and left-ventricular function after ligation of left coronary artery (Bland-White-Garland syndrome): a long-term follow-up. Thorac Cardiovasc Surg 1992; 40: 283–287.CrossRefGoogle ScholarPubMed
32.Wollenek, G, Domanig, E, Salzer-Muhar, U, Havel, M, Wimmer, M, Wolner, E. Anomalous origin of the left coronary artery: a review of surgical management in 13 patients. J Cardiovasc Surg (Torino) 1993; 34: 399–405.Google ScholarPubMed
33.Wilson, CL, Dlabal, PW, McGuire, SA. Surgical treatment of anomalous left coronary artery from pulmonary artery: follow-up in teenagers and adults. Am Heart J 1979; 98: 440–446.CrossRefGoogle ScholarPubMed
34.Jonas, RA. Anomalies of the coronary arteries. In: Jonas RA, DiNardo J, Laussen PC, Howe R, LaPierre R and Matte G (eds.). Comprehensive surgical management of congenital heart disease. Arnold, London, 2004, p 510–525.Google Scholar
35.Ando, Y, Kado, H, Masuda, M, et al. “Spiral-cuff” technique for repair of anomalous left coronary artery from the pulmonary artery. Ann Thorac Surg 2008; 86: 667–668.CrossRefGoogle ScholarPubMed
36.Yasui, H. Coronary anomalies. In: Yasui H, Kado H and Masuda M (eds.). Cardiovascular Surgery for Congenital Heart Disease. Springer, Tokyo, 2009, pp 234–239.CrossRefGoogle Scholar
37.Barth, MJ, Allen, BS, Gulecyuz, M, Chiemmongkoltip, P, Cuneo, B, Ilbawi, MN. Experience with an alternative technique for the management of anomalous left coronary artery from the pulmonary artery. Ann Thorac Surg 2003; 76: 1429–1434.CrossRefGoogle ScholarPubMed
38.Mavroudis, C, Backer, CL, Muster, AJ, et al. Expanding indications for pediatric coronary artery bypass. J Thorac Cardiovasc Surg 1996; 111: 181–189.CrossRefGoogle ScholarPubMed
39.Chan, RK, Hare, DL, Buxton, BF. Anomalous left main coronary artery arising from the pulmonary artery in an adult: treatment by internal mammary artery grafting. J Thorac Cardiovasc Surg 1995; 109: 393–394.CrossRefGoogle Scholar
40.Wernovsky, G, Wypij, D, Jonas, RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995; 92: 2226–2235.CrossRefGoogle ScholarPubMed
41.Hoffman, TM, Wernovsky, G, Atz, AM, et al. Prophylactic intravenous use of milrinone after cardiac operation in pediatrics (PRIMACORP) study. prophylactic intravenous use of milrinone After cardiac operation in pediatrics. Am Heart J 2002; 143: 15–21.CrossRefGoogle Scholar
42.Chang, AC, Atz, AM, Wernovsky, G, Burke, RP, Wessel, DL. Milrinone: systemic and pulmonary hemodynamic effects in neonates after cardiac surgery. Crit Care Med 1995; 23: 1907–1914.CrossRefGoogle ScholarPubMed
43.Nasseri, BA, Alexi-Meskishvili, V, Schmitt, B, et al. Preoperative predictors for postoperative left ventricular mechanical circulatory support after repair of anomalous left coronary artery origin from pulmonary artery. Society of Thoracic Surgeons, 46th Annual Meeting. Fort Lauderdale, Florida; 2010.Google Scholar
44.Ben Ali, W, Metton, O, Roubertie, F, et al. Anomalous origin of the left coronary artery from the pulmonary artery: late results with special attention to the mitral valve. Eur J Cardiothorac Surg 2009; 36: 244–248; discussion 8–9.CrossRefGoogle ScholarPubMed
45.del Nido, PJ, Duncan, BW, Mayer, JE Jr, Wessel, DL, LaPierre, RA, Jonas, RA. Left ventricular assist device improves survival in children with left ventricular dysfunction after repair of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 1999; 67: 169–172.CrossRefGoogle ScholarPubMed