Perioperative Management of Anomalous Origin of the Left Coronary Artery from Pulmonary Artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHENHua , JIABing , CHENZhang-gen , YEMing , TAOQi-lin , YANXian-gang , MIYa-ping ,  ZHUBing-xue

Cardiac Intensive Care Unit, Children's Hospital, Fudan University, Shanghai 201102, P. R. China;

Corresponding author：

ZHUBing-xue, Email: zzhzbx2003@aliyun.com

Keywords：

Perioperative period; Coronary artery anomaly; Infant

DOI：

10.7507/1007-4848.20150036

Video：

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Objective To summarize perioperative management experience of 16 patients undergoing surgical correction of anomalous origin of the left coronary artery from pulmonary artery (ALCAPA). Methods We performed a retrospective analysis of 16 patients who received surgical correction of ALCAPA between January 2005 and December 2013 in Cardiovascular Center of Children's Hospital of Fudan University. There were 6 males and 10 females with their age ranging from 2 months to 13 years (mean age of 23.25±0.63 months) and body weight ranging from 5 to 30 kg (mean body weight of 19.77±0.75 kg). All the patients underwent direct implantation of the anomalous coronary artery into the ascending aorta, and received comprehensive management regarding left ventricular ejection fraction (LVEF), heart rate, blood pressure, arterial blood gas, urinary volume, blood lactic acid and central venous pressure. Results Postoperative complications were low cardiac output syndrome (LCOS) in 9 patients (including intractable LCOS in 2 patients) and arrhythmia in 1 patient. One patient with intractable LCOS and arrhythmia died postoperatively with the mortality of 6.25%. Cardiopulmonary bypass time was 85-260 (135.61±35.01) minutes, aortic cross-clamping time was 40-97 (57.32±16.02) minutes, mechanical ventilation time was 34-187 (106.34±41.62) hours, length of CICU stay was 2-21 (8.13±5.02) days, and hospital stay was 12-51 (22.14±5.00) days. Postoperative LVEF and left ventricular fractional shortening were significantly higher than preoperative values (P < 0.05). Conclusion Key points for successful surgical correction of ALCAPA include meticulous perioperative management, preoperative heart function improvement, prevention of postoperative complications and use of new techniques.

Citation： SHENHua, JIABing, CHENZhang-gen, YEMing, TAOQi-lin, YANXian-gang, MIYa-ping, ZHUBing-xue. Perioperative Management of Anomalous Origin of the Left Coronary Artery from Pulmonary Artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(2): 128-131. doi: 10.7507/1007-4848.20150036 Copy

1.	Davis JA, Cecchin F, Jones TK, et al. Major coronary artery anomalies a pediatric population:in incidence and clinical importance. J Am Coll Cardiol, 2001, 37(2):593-597.
2.	Kazmierczak PA, Ostrowska K, Dryzek P, et al. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants. Interact Cardiovasc Thorac Surg, 2013, 16(6):797-801.
3.	Dodge-Khatami A, Mavroudis C, Backer CL, et al. Anomalous origin of the left coronary artery from the pulmonary artery:collective review of surgical therapy. Ann Thorac Surg, 2002, 74(3):946-955.
4.	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(2):244-248.
5.	Sato Y, Sakaguchi R, Innami Y, et al. Perioperative management of a patient with anomalous origin of the left coronary artery from the pulmonary artery. Masui, 2013, 62(10):1191-1193.
6.	Smith DE 3rd, Adams R, Argilla M, et al. A unique ALCAPA variant in a neonate. J Card Surg, 2013, 28(3):306-308.
7.	Caspi J, Pettitt TW, Sperrazza C, et al. Reimplantation of anomalous left coronary artery from the pulmonary artery without mitral valve repair. Ann Thorac Surg, 2007, 84(2):619-623.
8.	Vouhé PR, Tamisier D, Sidi D, et al. Anomalous left coronary artery from the pulmonary artery:results of isolated aortic reimplantation. Ann Thorac Surg, 1992, 54(4):621-626.
9.	Schwartz ML, Jonas RA, Colan SD. Anomalous origin of left coronary artery from pulmonary artery:recovery of left ventricular function after dualcoronary repair. J Am Coll Cardiol, 1997, 30(2):547-553.
10.	Brown JW, Ruzmetov M, Parent JJ, et al. 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(3):743-748.
11.	Tyrrell MJ, Duncan WJ, Hayton RC, et al. Anomalous left coronary artery from the pulmonary artery:effect of coronary anatomy on clinical course. Angiology, 1987, 38(11):833-840.
12.	Vouhé PR, Baillot-Vernant F, Trinquet F, et al. Anomalous left coronary artery from the pulmonary artery in infants. Which operation? When? J Thorac Cardiovasc Surg, 1987, 94(2):192-199.
13.	Lambert V, Touchot A, Losay J, et al. Midterm results after surgical repair of the anomalous origin of the coronary artery. Circulation, 1996, 94(9 Suppl):Ⅱ38-Ⅱ43.
14.	Samantaray A, Hemanth N. Comparison of two ventilation modes in post-cardiac surgical patients. Saudi J Anaesth, 2011, 5(2):173-178.
15.	D'Angio CT, Chess PR, Kovacs SJ, et al. Pressure-regulated volume control ventilation vs synchronized intermittent mandatory ventilation for very low-birth-weight infants:a randomized controlled trial. Arch Pediatr Adolesc Med, 2005, 159(9):868-875.
16.	张英, 安琪, 于风旭, 等.婴幼儿体外循环术后机械通气模式的选择.中国胸心血管外科临床杂志, 2006, 13(5):357-359.
17.	McElhinney DB, Reddy VM, Parry AJ, et al. Management and outcomes of delayed sternal closure after cardiac surgery in neonates and infants. Crit Care Med, 2000, 28(4):1180-1184.
18.	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(3):938-944.
19.	Hoffman TM, Wernovsky G, Atz AM, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation, 2003, 107(7):996-1002.
20.	Alkan T, Akçevin A, Türkoglu H, et al. Postoperative prophylactic peritoneal dialysis in neonates and infants after complex congenital cardiac surgery. ASAIO J, 2006, 52(6):693-697.

1. Davis JA, Cecchin F, Jones TK, et al. Major coronary artery anomalies a pediatric population:in incidence and clinical importance. J Am Coll Cardiol, 2001, 37(2):593-597.
2. Kazmierczak PA, Ostrowska K, Dryzek P, et al. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants. Interact Cardiovasc Thorac Surg, 2013, 16(6):797-801.
3. Dodge-Khatami A, Mavroudis C, Backer CL, et al. Anomalous origin of the left coronary artery from the pulmonary artery:collective review of surgical therapy. Ann Thorac Surg, 2002, 74(3):946-955.
4. 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(2):244-248.
5. Sato Y, Sakaguchi R, Innami Y, et al. Perioperative management of a patient with anomalous origin of the left coronary artery from the pulmonary artery. Masui, 2013, 62(10):1191-1193.
6. Smith DE 3rd, Adams R, Argilla M, et al. A unique ALCAPA variant in a neonate. J Card Surg, 2013, 28(3):306-308.
7. Caspi J, Pettitt TW, Sperrazza C, et al. Reimplantation of anomalous left coronary artery from the pulmonary artery without mitral valve repair. Ann Thorac Surg, 2007, 84(2):619-623.
8. Vouhé PR, Tamisier D, Sidi D, et al. Anomalous left coronary artery from the pulmonary artery:results of isolated aortic reimplantation. Ann Thorac Surg, 1992, 54(4):621-626.
9. Schwartz ML, Jonas RA, Colan SD. Anomalous origin of left coronary artery from pulmonary artery:recovery of left ventricular function after dualcoronary repair. J Am Coll Cardiol, 1997, 30(2):547-553.
10. Brown JW, Ruzmetov M, Parent JJ, et al. 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(3):743-748.
11. Tyrrell MJ, Duncan WJ, Hayton RC, et al. Anomalous left coronary artery from the pulmonary artery:effect of coronary anatomy on clinical course. Angiology, 1987, 38(11):833-840.
12. Vouhé PR, Baillot-Vernant F, Trinquet F, et al. Anomalous left coronary artery from the pulmonary artery in infants. Which operation? When? J Thorac Cardiovasc Surg, 1987, 94(2):192-199.
13. Lambert V, Touchot A, Losay J, et al. Midterm results after surgical repair of the anomalous origin of the coronary artery. Circulation, 1996, 94(9 Suppl):Ⅱ38-Ⅱ43.
14. Samantaray A, Hemanth N. Comparison of two ventilation modes in post-cardiac surgical patients. Saudi J Anaesth, 2011, 5(2):173-178.
15. D'Angio CT, Chess PR, Kovacs SJ, et al. Pressure-regulated volume control ventilation vs synchronized intermittent mandatory ventilation for very low-birth-weight infants:a randomized controlled trial. Arch Pediatr Adolesc Med, 2005, 159(9):868-875.
16. 张英, 安琪, 于风旭, 等.婴幼儿体外循环术后机械通气模式的选择.中国胸心血管外科临床杂志, 2006, 13(5):357-359.
17. McElhinney DB, Reddy VM, Parry AJ, et al. Management and outcomes of delayed sternal closure after cardiac surgery in neonates and infants. Crit Care Med, 2000, 28(4):1180-1184.
18. 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(3):938-944.
19. Hoffman TM, Wernovsky G, Atz AM, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation, 2003, 107(7):996-1002.
20. Alkan T, Akçevin A, Türkoglu H, et al. Postoperative prophylactic peritoneal dialysis in neonates and infants after complex congenital cardiac surgery. ASAIO J, 2006, 52(6):693-697.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative Management of Anomalous Origin of the Left Coronary Artery from Pulmonary Artery

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