Long-Term Assessment of Left Ventricular Ejection Fraction and Mitral Regurgitation Following Takeuchi Repair.

Gökmen Akkaya,Osman Nuri Tuncer,Çağatay Bilen,Mehmet Fatih Ayık,Yüksel Atay

doi:10.21470/1678-9741-2018-0376

Gökmen Akkaya, Osman Nuri Tuncer + Show 3 more

Open Access

https://doi.org/10.21470/1678-9741-2018-0376

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Abstract

ObjectiveThis study aimed to evaluate the early operative outcomes and to compare the left ventricle and mitral valve functions after initial Takeuchi repair in patients with anomalous left coronary arising from pulmonary artery (ALCAPA).MethodsFourteen patients (5 males, 9 females; mean age 4.3 years, ranging from 25 days to 34 years) who were operated for ALCAPA between 2007 and 2018 were included in this study. Data were evaluated retrospectively based on our medical records.ResultsHospital mortality rate was 7.1% (n=1). Thirteen surviving patients were kept in follow-up mean 4.3±3.05 years. When compared to preoperative measurements, both left ventricular ejection fraction (LVEF), (P=0.007) and mitral regurgitation (MR) (P=0.001) significantly improved before discharge. Moreover, LVEF values were improved in the late follow-up, considering early postoperative outcomes, and this alteration was significant (P=0.014). Nevertheless, alteration in the degree of MR among patients did not differ in the long-term follow-up (P=0.180). There was no late-term mortality or need for reoperation among patients.ConclusionAlthough some centers prefer to direct implantation in ALCAPA, Takeuchi procedure can be accepted as a reliable method that provides satisfactory long-term results, considering that it aids to improve left ventricle ejection fraction and reduced mitral valve regurgitation.

Highlights

Anomalous left coronary artery arising from the pulmonary artery (ALCAPA), known as Bland-White-Garland syndrome, is a very rare congenital coronary disorder that occurs in approximately 1 in 300,000 live births[1,2]
The patient could be weaned from Cardiopulmonary bypass (CPB) with inotropic support
We are in consensus with Sarıoglu et al.[7] that in every child diagnosed with dilated cardiomyopathy, anomalous left coronary arising from pulmonary artery (ALCAPA) must be excluded

Summary

Introduction

Anomalous left coronary artery arising from the pulmonary artery (ALCAPA), known as Bland-White-Garland syndrome, is a very rare congenital coronary disorder that occurs in approximately 1 in 300,000 live births[1,2]. When left untreated mortality rate may up to 90% within the first year of life, in the presence of sufficient intercoronary collateral flow, some cases survive even asymptomatic until adulthood[3]. Such cases are in danger of sudden death, as soon as the diagnosis is confirmed, regardless of age or clinical manifestation, surgical treatment establishing two coronary systems should be undertaken immediately[4]. With the help of advanced techniques and improved intensive care management, surgical correction provides satisfactory results and uneventful survival rate[5,6,7].

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