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

Authors：

Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding?author：

Keywords：

Anomalous left coronary artery from the pulmonary artery; Coronary artery re-implantation; Mitral regurgitation

DOI：

10.7507/1007-4848.20160006

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Objective To review the experience of the surgical treatment of child patients with anomalous left coronary artery from the pulmonary artery (ALCAPA). Methods We retrospectively analyzed the clinical data of 56 children patients with ALCAPA underwent coronary re-implantation in our hospital from April 2004 through February 2015. There were 35 males and 21 females at mean age of 25.5 (7.3-60.0) months. Nineteen patients (33.9%) were less than 1 year of age. The mean weight was 11.8 (7.8-19.8) kg. Results There was one death in-hospital. The mean cardiopulmonary bypass time and cross-clamp time was 131.8± 61.2 min and 83.4± 32.1min, respectively. The mean mechanical ventilation time and intensive care unit time was 12.5 (6.5-43.8) h and 49.0 (21.0-116.0) h, respectively. Three patients underwent extracorporeal membrane oxygenation (ECMO) support and weaned off successfully. The mean postoperative left ventricular ejection fraction (LVEF, 63.4%± 15.8% vs. 50.6%± 18.7%) and left ventricular end diastolic diameter (LVEDD, 36.4± 32.5 mm vs. 42.3± 7.4 mm) significantly improved compared postoperative (P < 0.05). The mitral regurgitation (MR) distribution in the 15 patients underwent mitral valve repair was:moderate in 2 patients, mild in 8 patients, trivial in 2 patients and none in 3 patients. The MR in the other 41 patients improved or did not change. The survivors completed the follow-up for a mean time of 45.4± 23.6 months. During the follow-up period, one patient died due to noncardiac reason. No patient required reoperation or readmission. All the patients survived with New York Heart Association heart function classⅠor classⅡ. At the latest echocardiography, the mean LVEF (62.8%± 5.0%) significantly improved compared with the LVEF of discharge. The MR distribution was moderate in 6 patients, mild in 24 patients, trivial in 4 patients and none in 21 patients. Conclusion The coronary re-implantation has a satisfactory mid-term result for patients with ALCAPA. Mitral valve repair is recommended for the patients with severe regurgitation and evident ischemic lesions of the papillary muscles.

Citation： ZHANGChang-wei, LIShou-jun, ZHANGHao, GAOHua-wei, CHANGYi, HUAZhong-dong, MAKai. Surgical Treatment of Children with Anomalous Left Coronary Artery from the Pulmonary Artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(1): 21-24. doi: 10.7507/1007-4848.20160006 Copy

1.	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.
2.	Lange R, Vogt M, Horer 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.
3.	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.
4.	Ma K, Wang L, Hua Z, et al. Outcomes of coronary transfer for anomalous origin of the left coronary artery from the pulmonary arterydagger. Eur J Cardiothorac Surg, 2014, 47(4) : 659-664.
5.	Weigand J, Marshall CD, Bacha EA, et al. Repair of anomalous left coronary artery from the pulmonary artery in the modern era: preoperative predictors of immediate postoperative outcomes and long term cardiac follow-up. Pediatr Cardiol, 2014, 36(3):489-497.
6.	何偉, 劉志勇, 李旭東, 等.左冠狀動脈再植術資料左冠狀動脈起源于肺動脈一例.中國胸心血管外科臨床雜志, 2009, 16(1): 80.
7.	沈華, 賈兵, 陳張根, 等.左冠狀動脈異常起源于肺動脈圍術期處理.中國胸心血管外科臨床雜志, 2015, 22(2): 128-131.
8.	李文秀, 耿斌, 李曉峰, 等.左冠狀動脈異常起源于肺動脈的外科治療.中國胸心血管外科臨床雜志, 2014, 21(5): 619-623.
9.	Talwar S, Jha AJ, Choudhary SK, et al. Repair of anomalous left coronary artery from pulmonary artery (ALCAPA) beyond infancy. Heart Surg Forum, 2015, 16(4): 210-215.
10.	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.
11.	Cramer JW, Cinquegrani M, Cohen SB. Takeuchi repair of anoma-lous left coronary artery from the pulmonary artery. J Cardiovasc Comput Tomogr, 2015, 9(5):457-458.
12.	Juan YH, Saboo SS, Keraliya A, et al. Coronary strictures, intralu-minal thrombus and aneurysms: Unreported imaging appearance of ALCAPA syndrome post Takeuchi procedure. Int J Cardiol, 2015, 186: 291-293.
13.	El-Rassi I, Soueide A, Sweid O, et al. Transfer technique of an anomalous coronary artery from the anterior pulmonary artery. Ann Thorac Surg, 2012, 93(5): 1738-1740.
14.	Suzuki T, Ittleman FP, Gogo PB, Jr. Atypical presentation of anom-alous origin of the left main coronary artery from the pulmonary artery. Ann Thorac Surg, 2009, 88(4): 1339-1341.
15.	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.
16.	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.
17.	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): 244-249.
18.	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.
19.	Ramirez S, Curi-Curi PJ, Calderon-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(8): 681-687.
20.	Browne LP, Kearney D, Taylor MD, et al. ALCAPA: the role of myocardial viability studies in determining prognosis. Pediatr Radiol, 2010, 40(2): 163-167.
21.	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.
22.	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.
23.	Zheng J, Ding W, Xiao Y, et al.Anomalous origin of the left coronary artery from the pulmonary artery in children: 15 years experience. Pediatr Cardiol, 2011, 32(1): 24-31.
24.	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.

1. 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.
2. Lange R, Vogt M, Horer 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.
3. 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.
4. Ma K, Wang L, Hua Z, et al. Outcomes of coronary transfer for anomalous origin of the left coronary artery from the pulmonary arterydagger. Eur J Cardiothorac Surg, 2014, 47(4) : 659-664.
5. Weigand J, Marshall CD, Bacha EA, et al. Repair of anomalous left coronary artery from the pulmonary artery in the modern era: preoperative predictors of immediate postoperative outcomes and long term cardiac follow-up. Pediatr Cardiol, 2014, 36(3):489-497.
6. 何偉, 劉志勇, 李旭東, 等.左冠狀動脈再植術資料左冠狀動脈起源于肺動脈一例.中國胸心血管外科臨床雜志, 2009, 16(1): 80.
7. 沈華, 賈兵, 陳張根, 等.左冠狀動脈異常起源于肺動脈圍術期處理.中國胸心血管外科臨床雜志, 2015, 22(2): 128-131.
8. 李文秀, 耿斌, 李曉峰, 等.左冠狀動脈異常起源于肺動脈的外科治療.中國胸心血管外科臨床雜志, 2014, 21(5): 619-623.
9. Talwar S, Jha AJ, Choudhary SK, et al. Repair of anomalous left coronary artery from pulmonary artery (ALCAPA) beyond infancy. Heart Surg Forum, 2015, 16(4): 210-215.
10. 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.
11. Cramer JW, Cinquegrani M, Cohen SB. Takeuchi repair of anoma-lous left coronary artery from the pulmonary artery. J Cardiovasc Comput Tomogr, 2015, 9(5):457-458.
12. Juan YH, Saboo SS, Keraliya A, et al. Coronary strictures, intralu-minal thrombus and aneurysms: Unreported imaging appearance of ALCAPA syndrome post Takeuchi procedure. Int J Cardiol, 2015, 186: 291-293.
13. El-Rassi I, Soueide A, Sweid O, et al. Transfer technique of an anomalous coronary artery from the anterior pulmonary artery. Ann Thorac Surg, 2012, 93(5): 1738-1740.
14. Suzuki T, Ittleman FP, Gogo PB, Jr. Atypical presentation of anom-alous origin of the left main coronary artery from the pulmonary artery. Ann Thorac Surg, 2009, 88(4): 1339-1341.
15. 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.
16. 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.
17. 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): 244-249.
18. 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.
19. Ramirez S, Curi-Curi PJ, Calderon-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(8): 681-687.
20. Browne LP, Kearney D, Taylor MD, et al. ALCAPA: the role of myocardial viability studies in determining prognosis. Pediatr Radiol, 2010, 40(2): 163-167.
21. 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.
22. 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.
23. Zheng J, Ding W, Xiao Y, et al.Anomalous origin of the left coronary artery from the pulmonary artery in children: 15 years experience. Pediatr Cardiol, 2011, 32(1): 24-31.
24. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment of Children with Anomalous Left Coronary Artery from the Pulmonary Artery

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