Surgical Treatment of Patients with Congenital Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XUYao-qiang ,  LIUYing-long , SUJun-wu , HEYan , LIZhi-qiang , FANXiang-ming

Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel diseases, Beijing 100029, P. R. China;

Corresponding author：

LIUYing-long, Email: liuyinglong@vip.sina.com

Keywords：

Coronary artery; Anomalous origin; Congenital heart defect; Surgery

DOI：

10.7507/1007-4848.20160106

Video：

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Objective To summarize the method and outcomes of surgical treatment for 21 patients with congenital anomalous left coronary artery from the pulmonary artery (ALCAPA). Methods We retrospectively analyzed the clinical data of 21 patients with ALCAPA underwent surgical treatment in our center from January 2010 to January 2015. There were 11 males and 10 females with a mean age of 4.3 years (ranging from 0.5 to 16.0 years) and a mean weight of 19.3 kg (ranging from 5.0 to 97.0 kg). All of 21 patients underwent surgery under cardiopulmonary bypass and corrected malformations. Results There were 2 perioperative deaths and the mortality rate was 9.5%. The mean cardiopulmonary bypass time was 116.6 minutes ranging from 109.0 to 388.0 minutes and the mean aortic cross clamping time was 82.9 minutes ranging from 62.0 to 129.0 minutes. The mean time of hospital stay was 11.1 days ranging from 1.0 to 25.0 days. After surgery, cardiac function improved significantly in all patients. The mean left ventricular ejection fraction (EF), left ventricular fractional shortening (FS), and left ventricular end-diastolic diameter (LVEDD) have significantly improved after surgery (P < 0.05). Conclusions Once patients with ALPACA are diagnosed, they should be treated with surgery and most of them will achieve a satisfactory long term clinical result.

Citation： XUYao-qiang, LIUYing-long, SUJun-wu, HEYan, LIZhi-qiang, FANXiang-ming. Surgical Treatment of Patients with Congenital Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(5): 449-452. doi: 10.7507/1007-4848.20160106 Copy

1.	Uysal F, Bostan OM, Semizel E, et al. Congenital anomalies of coronary arteries in children:the evaluation of 22 patients. Pediatr Cardiol, 2014, 35(5):778-784.
2.	Cherian KM, Bharati S, Rao SG. Surgical correction of anomalous origin of the left coronary artery from the pulmonary artery. J Card Surg, 1994, 9(4):386-391.
3.	Szmigielska A, Roszkowska-Blaim M, Gołąbek-Dylewska M, et al. Bland-White-Garland syndrome-a rare and serious cause of failure to thrive. Am J Case Rep, 2013, 14(5):370-372.
4.	Molaei A, Rastkar Hemmati B, Khosroshahi H, et al. Misdiagnosis of bland-white-garland syndrome:report of two cases with different presentations. J Cardiovasc Thorac Res, 2014, 6(1):65-67.
5.	Kristensen T, Kofoed KF, Helqvist S, et al. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) presenting with ventricular fibrillation in an adult:a case report. J Cardiothorac Surg, 2008, 3(5):33.
6.	Courand PY, Bozio A, Ninet J, et al. Focus on echocardiographic and Doppler analysis of coronary artery abnormal origin from the pulmonary trunk with mild myocardial dysfunction. Echocardio-graphy, 2013, 30(7):829-836.
7.	Pisacane C, Pinto SC, De Gregorio P, et al. "Steal" collaterals:an echocardiographic diagnostic marker for anomalous origin of the left main coronary artery from the pulmonary artery in the adult. J Am Soc Echocardiogr, 2006, 19(1):107.
8.	Day K, Avery R, Oliva I, et al. Coronary CTA appearance of anom-alous left coronary artery arising from the pulmonary artery with intramural aortic route. Int J Cardiovasc Imaging, 2014, 30(2):241-243.
9.	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(4):1425-1436.
10.	Peña E, Nguyen ET, Merchant N, et al. ALCAPA syndrome:not just a pediatric disease. Radiographics, 2009, 29(2):553-565.
11.	Schuck R, Abd El Rahman MY, Rentzsch A, et al. Altered right ventricular function in the long-term follow-up evaluation of patients after delayed aortic reimplantation of the anomalous left coronary artery from the pulmonary artery. Pediatr Cardiol, 2014, 35(3):530-535.
12.	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(5):1535-1541.
13.	Muzaffar T, Ahmad Ganie F, Gpoal Swamy S, et al. The surgical outcome of anomalous origin of the left coronary artery from the pulmonary artery. Int Cardiovasc Res J, 2014, 8(2):57-60.
14.	Ginde S, Earing MG, Bartz PJ, et al. Late complications after Takeuchi repair of anomalous left coronary artery from the pulmonary artery:case series and review of literature. Pediatr Cardiol, 2012, 33(7):1115-1123.
15.	Alsoufi B, Sallehuddin A, Bulbul Z, et al. Surgical strategy to estab-lish a dual-coronary system for the management of anomalous left coronary artery origin from the pulmonary artery. Ann Thorac Surg, 2008, 86(1):170-176.
16.	Rajbanshi BG, Burkhart HM, Schaff HV, et al. Surgical strategies for anomalous origin of coronary artery from pulmonary artery in adults. J Thorac Cardiovasc Surg, 2014, 148(1):220-224.
17.	Gopal M, Maskari S, Zacharias S, et al. Coronary artery grafting in infants. Images Paediatr Cardiol, 2009, 11(2):9-14.
18.	Georgiev SG, Lazarov SD, Mitev ID, et al. Left ventricular and mitral valve function long after repair of left anomalous coronary artery from the pulmonary artery:recovery years after severe ische-mia. World J Pediatr Congenit Heart Surg, 2012, 3(3):321-327.
19.	Schwartz ML, Jonas RA, Colan SD. Anomalous origin of left coro-nary artery from pulmonary artery:recovery of left ventricular function after dual coronary repair. J Am Coll Cardiol, 1997, 30(2):547-553.
20.	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(3):856-860.
21.	Ben AW, 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.
22.	Cabrera AG, Chen DW, Pignatelli RH, et al. Outcomes of anoma-lous left coronary artery from pulmonary artery repair:beyond normal function. Ann Thorac Surg, 2015, 99(4):1342-1347.
23.	Bakhtiary F, Mohr FW, Kostelka M. Midterm outcome after surgical correction of anomalous left coronary artery from pulmonary artery. World J Pediatr Congenit Heart Surg, 2011, 2(4):550-553.
24.	del Nido PJ, Duncan BW, Mayer JE, et al. Left ventricular assist device improves survival in children with left ventricular dysfun-ction after repair of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg, 1999, 67(1):169-172.

1. Uysal F, Bostan OM, Semizel E, et al. Congenital anomalies of coronary arteries in children:the evaluation of 22 patients. Pediatr Cardiol, 2014, 35(5):778-784.
2. Cherian KM, Bharati S, Rao SG. Surgical correction of anomalous origin of the left coronary artery from the pulmonary artery. J Card Surg, 1994, 9(4):386-391.
3. Szmigielska A, Roszkowska-Blaim M, Gołąbek-Dylewska M, et al. Bland-White-Garland syndrome-a rare and serious cause of failure to thrive. Am J Case Rep, 2013, 14(5):370-372.
4. Molaei A, Rastkar Hemmati B, Khosroshahi H, et al. Misdiagnosis of bland-white-garland syndrome:report of two cases with different presentations. J Cardiovasc Thorac Res, 2014, 6(1):65-67.
5. Kristensen T, Kofoed KF, Helqvist S, et al. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) presenting with ventricular fibrillation in an adult:a case report. J Cardiothorac Surg, 2008, 3(5):33.
6. Courand PY, Bozio A, Ninet J, et al. Focus on echocardiographic and Doppler analysis of coronary artery abnormal origin from the pulmonary trunk with mild myocardial dysfunction. Echocardio-graphy, 2013, 30(7):829-836.
7. Pisacane C, Pinto SC, De Gregorio P, et al. "Steal" collaterals:an echocardiographic diagnostic marker for anomalous origin of the left main coronary artery from the pulmonary artery in the adult. J Am Soc Echocardiogr, 2006, 19(1):107.
8. Day K, Avery R, Oliva I, et al. Coronary CTA appearance of anom-alous left coronary artery arising from the pulmonary artery with intramural aortic route. Int J Cardiovasc Imaging, 2014, 30(2):241-243.
9. 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(4):1425-1436.
10. Peña E, Nguyen ET, Merchant N, et al. ALCAPA syndrome:not just a pediatric disease. Radiographics, 2009, 29(2):553-565.
11. Schuck R, Abd El Rahman MY, Rentzsch A, et al. Altered right ventricular function in the long-term follow-up evaluation of patients after delayed aortic reimplantation of the anomalous left coronary artery from the pulmonary artery. Pediatr Cardiol, 2014, 35(3):530-535.
12. 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(5):1535-1541.
13. Muzaffar T, Ahmad Ganie F, Gpoal Swamy S, et al. The surgical outcome of anomalous origin of the left coronary artery from the pulmonary artery. Int Cardiovasc Res J, 2014, 8(2):57-60.
14. Ginde S, Earing MG, Bartz PJ, et al. Late complications after Takeuchi repair of anomalous left coronary artery from the pulmonary artery:case series and review of literature. Pediatr Cardiol, 2012, 33(7):1115-1123.
15. Alsoufi B, Sallehuddin A, Bulbul Z, et al. Surgical strategy to estab-lish a dual-coronary system for the management of anomalous left coronary artery origin from the pulmonary artery. Ann Thorac Surg, 2008, 86(1):170-176.
16. Rajbanshi BG, Burkhart HM, Schaff HV, et al. Surgical strategies for anomalous origin of coronary artery from pulmonary artery in adults. J Thorac Cardiovasc Surg, 2014, 148(1):220-224.
17. Gopal M, Maskari S, Zacharias S, et al. Coronary artery grafting in infants. Images Paediatr Cardiol, 2009, 11(2):9-14.
18. Georgiev SG, Lazarov SD, Mitev ID, et al. Left ventricular and mitral valve function long after repair of left anomalous coronary artery from the pulmonary artery:recovery years after severe ische-mia. World J Pediatr Congenit Heart Surg, 2012, 3(3):321-327.
19. Schwartz ML, Jonas RA, Colan SD. Anomalous origin of left coro-nary artery from pulmonary artery:recovery of left ventricular function after dual coronary repair. J Am Coll Cardiol, 1997, 30(2):547-553.
20. 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(3):856-860.
21. Ben AW, 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.
22. Cabrera AG, Chen DW, Pignatelli RH, et al. Outcomes of anoma-lous left coronary artery from pulmonary artery repair:beyond normal function. Ann Thorac Surg, 2015, 99(4):1342-1347.
23. Bakhtiary F, Mohr FW, Kostelka M. Midterm outcome after surgical correction of anomalous left coronary artery from pulmonary artery. World J Pediatr Congenit Heart Surg, 2011, 2(4):550-553.
24. del Nido PJ, Duncan BW, Mayer JE, et al. Left ventricular assist device improves survival in children with left ventricular dysfun-ction after repair of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg, 1999, 67(1):169-172.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment of Patients with Congenital Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

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