Clinical efficacy of reimplantation of anomalous origin of the left coronary artery from the pulmonary artery: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Haijiang ,  ZHUANG Jian , CHEN Jimei , CEN Jianzheng , XU Gang , WEN Shusheng , TENG Yun

Department of Cardiac Surgery, Guangdong General Hospital, Guangdong Academic of Medical Science, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510100, P.R.China;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@tom.com

Keywords：

Heart defects, congenital; cardiac surgical procedures; left coronary artery; anomalous origin; pulmonary artery; mitral regurgition

DOI：

10.7507/1007-4848.201706057

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Objective To analyze the clinical efficacy and mid-term outcomes of reimplantation of anomalous origin of left coronary artery from the pulmonary artery (ALCAPA), and to evaluate whether concomitant management of mitral regurgitation (MR) during ALCAPA repair is needed. Methods Between March 2005 and March 2015, 52 consecutive patients (20 males and 32 females with a median age of 10 months ranging 2-193 months) underwent reimplantation of ALCAPA at Department of Cardiac Surgery, Guangdong Cardiovascular Institute. There were 14 males and 21 females with a mean age of 35.4±42.8 months not receiving mitral valvuloplasty (a Non-MVP group), and 6 males and 11 females with a mean age of 13.5±11.0 months receiving mitral valvuloplasty (a MVP group). In order to facilitate the analysis, degree of MR was graded by number: 0.0=none, 1.0=trivial, 2.0=mild, 2.5=mild-moderate, 3.0=moderate, 3.5=moderate-severe and 4.0=severe. Results The left ventricular fractional shortening (LVFS) and left ventricular end diastolic diameter (LVEDD) demonstrated significant improvement between preoperation and discharge (28.6%±9.6% vs. 32.1%±10.1%, P=0.023; 38.4±5.6 mm vs. 30.5±5.7 mm, P<0.001), and there was also significant improvement in the mean MR grade between preoperation and discharge (2.9±1.2,vs. 2.4±1.2, P=0.001). There were 4 in-hospital deaths (7.7%). The median follow-up was 21.0 months (ranging 1.5-111.0 months). Three patients (5.8%) were lost to follow-up, 1 patient required reoperation for mitral valve replacement and there was no death during follow-up. Significant improvement was seen in LVFS between discharge and final follow-up (32.1%±10.1% vs. 38.0%±6.0%, P=0.001); however, there was no significant difference in the degree of MR between discharge and final follow-up (2.4±1.2 vs. 2.3±1.2, P=0.541). There was no significant difference in cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time or hospital stay between the two groups. Conclusion Creation of a dual coronary system with reimplantation of the left coronary artery results in complete recovery of left ventricular function. However, concomitant management of MR during ALCAPA repair remains controversial. Concomitant mitral valve repair for ALCAPA patients with moderate-severe and severe MR is helpful to early function recovery of mitral valve.

Citation： GUO Haijiang, ZHUANG Jian, CHEN Jimei, CEN Jianzheng, XU Gang, WEN Shusheng, TENG Yun. Clinical efficacy of reimplantation of anomalous origin of the left coronary artery from the pulmonary artery: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(3): 198-202. doi: 10.7507/1007-4848.201706057 Copy

1.	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(3): 946-955.
2.	陈欣欣, 卢聪, 庄建, 等. 左冠状动脉异常起源于肺动脉的诊断和外科治疗. 中华胸心血管外科杂志, 2006, 22(1): 18-20.
3.	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.
4.	Hetzer R, Delmo Walter EB, Hübler M, et al. Modified surgical techniques and long-term outcome of mitral valve reconstruction in 111 children. Ann Thorac Surg, 2008, 86(2): 604-613.
5.	Peña E, Nguyen ET, Merchant N, et al. ALCAPA syndrome: not just a pediatric disease. Radiographics, 2009, 29(2): 553-565.
6.	Mongé 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(1): 154-160.
7.	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.
8.	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.
9.	Lenzi AW, Solarewicz L, Ferreira WS, et al. Analysis of the Takeuchi procedure for the treatment of anomalous origin of the left coronary artery from the pulmonary artery. Arq Bras Cardiol, 2008, 90(3): 167-171.
10.	Isomatsu Y, Imai Y, Shin'oka T, et al. Surgical intervention for anomalous origin of the left coronary artery from the pulmonary artery: the Tokyo experience. J Thorac Cardiovasc Surg, 2001, 121(4): 792-797.
11.	Martín Raymondi D, Mejía Viana S, Berenguel Senén A, et al. Supravalvular pulmonary stenosis as a late complication of surgery for anomalous coronary origin. J Thorac Cardiovasc Surg, 2002, 123(6): 1218-1220.
12.	Nasseri BA, Alexi-Meskishvili V, Nordmeyer S, et al. Predictors for the use of left ventricular assist devices in infants with anomalous left coronary artery from the pulmonary artery. Ann Thorac Surg, 2010, 90(2): 580-587.
13.	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.
14.	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(4): 868-874.
15.	Kirbas A, Gurer O, Bilal MS. Intermediate-term results after surgery for anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Cardiovasc Surg, 2012, 18(1): 12-17.
16.	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.
17.	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(5): 1842-1848.
18.	Lange R, Vogt M, Hörer J, et al. Long-term results of repair of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg, 2007, 83(4): 1463-1471.
19.	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.

1. 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(3): 946-955.
2. 陈欣欣, 卢聪, 庄建, 等. 左冠状动脉异常起源于肺动脉的诊断和外科治疗. 中华胸心血管外科杂志, 2006, 22(1): 18-20.
3. 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.
4. Hetzer R, Delmo Walter EB, Hübler M, et al. Modified surgical techniques and long-term outcome of mitral valve reconstruction in 111 children. Ann Thorac Surg, 2008, 86(2): 604-613.
5. Peña E, Nguyen ET, Merchant N, et al. ALCAPA syndrome: not just a pediatric disease. Radiographics, 2009, 29(2): 553-565.
6. Mongé 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(1): 154-160.
7. 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.
8. 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.
9. Lenzi AW, Solarewicz L, Ferreira WS, et al. Analysis of the Takeuchi procedure for the treatment of anomalous origin of the left coronary artery from the pulmonary artery. Arq Bras Cardiol, 2008, 90(3): 167-171.
10. Isomatsu Y, Imai Y, Shin'oka T, et al. Surgical intervention for anomalous origin of the left coronary artery from the pulmonary artery: the Tokyo experience. J Thorac Cardiovasc Surg, 2001, 121(4): 792-797.
11. Martín Raymondi D, Mejía Viana S, Berenguel Senén A, et al. Supravalvular pulmonary stenosis as a late complication of surgery for anomalous coronary origin. J Thorac Cardiovasc Surg, 2002, 123(6): 1218-1220.
12. Nasseri BA, Alexi-Meskishvili V, Nordmeyer S, et al. Predictors for the use of left ventricular assist devices in infants with anomalous left coronary artery from the pulmonary artery. Ann Thorac Surg, 2010, 90(2): 580-587.
13. 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.
14. 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(4): 868-874.
15. Kirbas A, Gurer O, Bilal MS. Intermediate-term results after surgery for anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Cardiovasc Surg, 2012, 18(1): 12-17.
16. 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.
17. 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(5): 1842-1848.
18. Lange R, Vogt M, Hörer J, et al. Long-term results of repair of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg, 2007, 83(4): 1463-1471.
19. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of reimplantation of anomalous origin of the left coronary artery from the pulmonary artery: A case control study

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