Surgical Repair Of Anomalous Origin Research Articles

Long-Term Outcomes after Surgical Repair of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Difference in Terms of Age at Operation

Long-Term Outcomes after Surgical Repair of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Difference in Terms of Age at Operation

Outcomes of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children.

Anomalous origin of the left coronary artery from the pulmonary artery is associated with high mortality if not timely surgery. We reviewed our experience with anomalous origin of the left coronary artery from the pulmonary artery to assess the preoperative variables predictive of outcome and post-operative recovery of left ventricular function. A retrospective review was conducted and collected data from patients who underwent anomalous origin of the left coronary artery from the pulmonary artery repair at our institute from April 2005 to December 2019. Left ventricular function was assessed by ejection fraction and the left ventricular end-diastolic dimension index. The outcomes of reimplantation repair were analysed. A total of 30 consecutive patients underwent anomalous origin of the left coronary artery from the pulmonary artery repair, with a median age of 14.7 months (range, 1.5-59.6 months), including 14 females (46.67%). Surgery was performed with direct coronary reimplantation in 12 patients (40%) and the coronary lengthening technique in 18 (60%). Twelve patients had concomitant mitral annuloplasty. There were two in-hospital deaths (6.67%), no patients required mechanical support, and no late deaths occurred. Follow-up echocardiograms demonstrated significant improvement between the post-operative time point and the last follow-up in ejection fraction (49.43%±19.92% vs 60.21%±8.27%, p < 0.01) and in moderate or more severe mitral regurgitation (19/30 vs 5/28, p < 0.01). The left ventricular end-diastolic dimension index decreased from 101.91 ± 23.07 to 65.06 ± 12.82 (p < 0.01). Surgical repair of anomalous origin of the left coronary artery from the pulmonary artery has good mid-term results with low mortality and reintervention rates. The coronary lengthening technique has good operability and leads to excellent cardiac recovery. The decision to concomitantly correct mitral regurgitation should be flexible and be based on the pathological changes of the mitral valve and the degree of mitral regurgitation.

The outcome of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in infants

BackgroundAnomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation in infants presenting with angina, dyspnea, and excessive perspiration invoked by crying and feeding. The aim of this study was to evaluate the factors affecting morbidity and the use of extracorporeal membrane oxygenation (ECMO) and to assess the quality of life post-repair.MethodsIn this retrospective study, information about five infants who underwent ALCAPA repair was collected from the databases of two tertiary referral cardiac centers (King Abdulaziz University Hospital and King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia) from 2011 to 2018. The patients were diagnosed using echocardiography, and data including mitral insufficiency and ejection fraction were assessed preoperatively and postoperatively. Quality of life was assessed using a questionnaire-based interview.ResultsThe median (range) age at the time of repair was 95 (34–144) days, and the median weight was 4.9 (3–5.7) kg. Two patients underwent the Takeuchi procedure, and three patients underwent left coronary artery reimplantation and translocation to the aorta. The median preoperative ejection fraction was 25 (12.5–45)%, and at the last follow-up, the median EF of the three survivors was 59 (50–70)%. There was no significant change in mitral insufficiency grade postoperatively. Two patients had ECMO support and died postoperatively. The infants who died were younger (< 75 days) and had lower weight (< 4.5 kg) at the time of intervention. Patients who survived showed good quality of life were asymptomatic and had heart function within the normal range.ConclusionEchocardiography and CT angiogram are effective tools for ALCAPA diagnosis in pediatric patients. Low weight at time or repair was associated with increased morbidity and ECMO did not increase survival.

Long‑term outcome after surgical repair of anomalous origin of the left coronary artery from the pulmonary artery: 24 years of experience.

Long‑term outcome after surgical repair of anomalous origin of the left coronary artery from the pulmonary artery: 24 years of experience.

Early and midterm results after surgical repair of anomalous origin of the left coronary artery from the pulmonary artery

Introduction/Objective. The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is rare congenital disease, which causes myocardial ischemia and subsequent heart failure in infants. The aim is early and mid-term follow up evaluation of the heart function after surgical repair of ALCAPA. Methods. Investigation was retrospective and included medical records of the ALCAPA patients treated surgically, between 2009 and 2017, at the tertiary referent heart center. Results. Five patients (four girls) with coronary anomaly were included in the study. All patients had significantly increased left ventricular end diastolic diameter (z-score 6.6 ? 2.43) and left atria size (z-score 3.09 ? 0.37), along with decreased systolic function (ejection fraction 34.8 ? 7.4% and fractional shortening 15.5 ? 3.4%). The surgery was performed on average at the age of 8.2 ? 7.8 months. Operative treatment was associated with early improvement in echocardiographic parameters (except the size of the left atria). Patients were followed for 4.5 ? 2.6 years. Improvement in echocardiographic parameters was age-related. Patients under four months had recovery early after surgery, those treated at 5.5?6 months of age had normalization after 12 months, and patient who was recognized in the second year of life had late recovery (after ? 24 months). Conclusion. Operative treatment in the first 3?4 months of life is related with the most favorable prognosis and rapid normalization of the echocardiographic parameters.

Restoring Fetal Circulation as a Means of Bridging Treatment Prior to Surgical Repair of Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta with Persistent Pulmonary Hypertension of the Newborn.

Anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital anomaly. Even more rarely reported is its presence in conjunction with persistent pulmonary hypertension of the newborn (PPHN). We present a case of a full-term infant, initially thought to have PPHN and later found to have anomalous origin of the right pulmonary artery from the ascending aorta. We discuss our management concept which included use of PgE1 infusion to restore fetal circulation prior to surgical treatment in this unique clinical scenario.

Repair of Intramural Coronary Artery in Anomalous Aortic Origin of a Coronary Artery

It has become increasingly evident that anomalous aortic origin of a coronary artery is considered as an important anatomic anomaly in adolescents and adults. The question is whether or not surgical repair should be performed in asymptomatic patients. Previous reports showed that the numbers of asymptomatic patients who result in a sudden cardiac death are not negligible. Another reason to proceed to surgical intervention is the improvement in understanding this unique anatomy and the refinement of surgical techniques that brought the satisfied outcomes. Physiologic repair, that is, coronary artery bypass grafting was used to be the first choice of surgery; however, anatomic repair, such as coronary implantation and repair of intramural coronary artery is considered favorable in adolescents as "radical" oppose to "palliative" repair. We report our technique to relieve the intramural coronary artery based on the experience in arterial switch operation performed in neonates.

Twenty-Year Outcome of Anomalous Origin of Left Coronary Artery From Pulmonary Artery: Management of Mitral Regurgitation

This study is a single-center experience with surgical repair of anomalous origin of left coronary artery from pulmonary artery (ALCAPA) with focus on the management of associated mitral regurgitation (MR). We performed a retrospective analysis of cases presenting to a quaternary referral center between November 1990 and October 2011. In all, 25 patients (18 female) presented with a diagnosis of ALCAPA at a median age of 5 months (range, 1.5 to 102). Twenty-one patients (84%) had moderate to severe impairment of left ventricular function with median fractional shortening of 14% (range, 2% to 33%), and 19 patients (76%) had moderate to severe MR. Surgery was performed with direct coronary reimplantation in 16 patients (64%) and intrapulmonary tunnel (Takeuchi repair) in 9 (36%). Four patients had mitral valve repair at time of surgery, all for structural anomalies. Functional MR with a structurally normal mitral valve was not repaired. The median duration of postoperative follow-up was 93 months (range, 9 to 240). There were no early or late deaths, and no patient required mechanical support. Four patients (16%) required surgical or catheter reintervention. At last follow-up, 24 of 25 patients were asymptomatic; the left ventricular function was normal in 22 patients. Moderate MR was present in 4 patients. There was significant improvement in left ventricular function and MR (p < 0.01) during follow-up. Surgical repair of ALCAPA has good long-term results with low mortality and reintervention rates. The majority of MR is functional and will improve with reperfusion, but structural mitral valve abnormalities should be repaired at the time of surgery.

Anomalous origin of the pulmonary artery from the aorta: early diagnosis and repair leading to immediate physiological correction

Anomalous origin of one pulmonary artery from the ascending aorta is a rare cardiac anomaly in which the pulmonary artery abnormally arises from the ascending aorta. Physiologically, most patients develop signs of cardiac failure due to high flow to both lungs, with systemic or supra-systemic pressures in the normally connected lung. The purpose of this study is to present our experience with this rare anomaly, in which early anatomic repair lead to rapid physiologic correction. Retrospective case review of all patients with anomalous origin of one pulmonary artery from the ascending aorta at Schneider Children's Medical center of Israel between 1986 and 2007. All clinical operative and echocardiographic charts were analysed. Twelve patients were diagnosed as anomalous origin of one pulmonary artery from the ascending aorta. In 10 patients, the right pulmonary artery rose from the ascending aorta, while in two an anomalous origin of the left pulmonary artery was associated with a right aortic arch. Initial diagnoses was made with two-dimensional echocardiography in all patients. In six patients, diagnostic cardiac catheterisation was performed in order to confirm the diagnosis. Age at diagnosis ranged from 5 to 180 days with a median of 15 days, and patient weight ranged from 780 grams to 5 kilograms, with a median of 3 kilograms. Initial echocardiographic evaluation showed systemic (four patients) or supra-systemic (seven patients) pressures in the right ventricle and normally connected lung. All underwent surgical repair. There was no operative mortality. All reconstructed patients achieved normal right ventricular pressures within days after surgery. The flow pattern in both pulmonary arteries was normalised. Early surgical repair of anomalous origin of one pulmonary artery from the ascending aorta is feasible and safe even in newborn and premature babies with complete resolution of the pulmonary hypertension and normalisation of pulmonary vascular resistance.

Surgical Repair of Anomalous Origin of the Left Coronary Artery Arising From the Left Pulmonary Artery

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly. We report an extremely uncommon variety of ALCAPA, in which the left coronary artery arose from the left pulmonary artery in a patient who presented with severe heart failure in early infancy. After direct reimplantation of the left coronary artery into the ascending aorta, the patient's cardiac function recovered successfully.

Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course

Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course

Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course

ObjectivesIn this study, we sought to describe the mode of presentation, anatomic features, diagnostic techniques, and surgical outcome in a group of patients with anomalous origin of a coronary artery from the opposite sinus with an interarterial course between the great arteries (AOCA). BackgroundAnomalous origin of a coronary artery from the opposite sinus with an interarterial course is associated with myocardial ischemia and sudden cardiac death, particularly in adolescents and young adults. MethodsThe cardiology database at Children’s Hospital of Wisconsin was reviewed to identify all patients diagnosed with AOCA. ResultsFrom September 1997 to August 2002, 10 patients were identified with AOCA; all were children/adolescents (age range, 3 months to 20 years; weight range, 4.7 to 72 kg), and nine were diagnosed prospectively by transthoracic echocardiography (TTE). Symptoms of cardiac ischemia initiated investigation in 4/10 patients at a mean age of 16 ± 2.8 years; the other six had TTE for suspected congenital heart disease/musculoskeletal chest pain. The left coronary artery originated from the right sinus in six patients, and the right coronary artery originated from the left sinus in four patients. An intramural course of the AOCA within the anterior aortic wall was found in 9/10 patients and was reliably identified by TTE; the other patient had an intramyocardial course of the anomalous coronary. Surgical repair was performed in 8/10 patients at a mean age of 13 ± 4.7 years. Unroofing of the intramural portion of the AOCA to relocate the ostia in the appropriate sinus was successfully performed in seven patients. All patients status post unroofing were asymptomatic with patent coronary flow by Doppler and normal exercise treadmill testing at a median follow-up interval of 1.5 years. ConclusionsAnomalous origin of a coronary artery from the opposite sinus with an interarterial course is frequently characterized by an intramural course, which can be prospectively identified by TTE. Unroofing the intramural segment without bypass grafting can reliably repair the intramural form of AOCA.

Prospective echo diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course

Prospective echo diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course

Surgical Repair of Anomalous Origin of the Coronary Artery from the Pulmonary Artery in Children

Objective: To evaluate surgical management of children with coronary artery anomalies, including patients with rare abnormalities (left anterior descending artery or right coronary artery originating from the pulmonary artery). Methods: A retrospective review of eight patients (aged 2 months-10 yr; median 3.5 yr), treated for coronary artery anomalies between 1989 and 1999. Coronary vessels were reimplanted to the aorta in four children, while the remaining four were subjected to the Takeuchi procedure. Results: All children survived. None required mechanical circulatory support. In six patients significant mitral valve insufficiency developed, nevertheless, no intraoperative mitral valvuloplasty was performed. Follow-up was 2 months-10 yr. All patients developed normally and are currently in NYHA class I. Echocardiography revealed normal FS and EF values within 1–17 months postoperatively. Conclusions: In children with coronary artery anomalies, the best results are achieved with an early diagnosis and aggressive management. In our opinion coronary vessel reimplantation and the Takeuchi procedure yields comparable results.

Surgical repair of anomalous origin of the coronary artery from the pulmonary artery in children

Objective: To evaluate surgical management of children with coronary artery anomalies, including patients with rare abnormalities (left anterior descending artery or right coronary artery originating from the pulmonary artery).Methods: A retrospective review of eight patients (aged 2 months–10 yr; median 3.5 yr), treated for coronary artery anomalies between 1989 and 1999. Coronary vessels were reimplanted to the aorta in four children, while the remaining four were subjected to the Takeuchi procedure.Results: All children survived. None required mechanical circulatory support. In six patients significant mitral valve insufficiency developed, nevertheless, no intraoperative mitral valvuloplasty was performed. Follow-up was 2 months–10 yr. All patients developed normally and are currently in NYHA class I. Echocardiography revealed normal FS and EF values within 1–17 months postoperatively.Conclusions: In children with coronary artery anomalies, the best results are achieved with an early diagnosis and aggressive management. In our opinion coronary vessel reimplantation and the Takeuchi procedure yields comparable results.

Intraaortic Balloon Pump After Treatment of Anomalous Origin of Left Coronary Artery

The same system of intraaortic balloon pumping has been used in 2 infants after surgical repair of anomalous origin of the left coronary artery from the main pulmonary artery. Intraaortic balloon pumping was started in the first patient on the second postoperative day, whereas in the second patient it was started before the patient was weaned from cardiopulmonary bypass. Both patients survived. In the first patient intraaortic balloon pumping improved the low cardiac output, which had failed to respond to maximal inotropic support, whereas in the second it maintained hemodynamic stability.

985-62 Outcome of Anomalous Origin of the Left Coronary Artery

The outcome after surgical repair of anomalous origin of the left coronary artery from the pulmonary trunk (ALCAPA) remains incompletely defined, and transplantation has been advocated for patients with severe left ventricular dysfunction. We reviewed our institutional experience with ALCAPA since 1977 in 38 patients whose repair established a dual coronary circulation (7 early cases with LCA ligation were excluded) to assess whether cardiac function predicts outcome, the use of left ventricular assist device (LVAD), and postoperative complications of the current operative techniques. Surgical techniques included direct coronary reimplantation to the aorta in 11 pts, intrapulmonary baffling (Takeuchi) when the LCA could not reach the aorta directly in 25 pts, and modified Takeuchi in which an extrapulmonary baffle was fashioned from anterior and posterior walls of the pulmonary artery in 2 pts. The operative survival was 91%, 88%, and 100%, respectively (89% overall). All pts who died were &lt; lyr old (3/19 Takeuchi, 1/10 reimplantation). Since its introduction at our institution in 1990, LVAD has been used in 4/16 pts, 1 Takeuchi pt who died and 3 reimplantation pts who all survived. Survival in pts &lt; 1 yr old was not different in those with severe dysfunction (shortening fraction (SF) &lt; 15%,18/20) compared with moderate dysfunction (SF 16–25%, 4/5). Function returned to normal in all pts for whom followup is known past one year, regardless of the severity of preoperative dysfunction. Postoperative complications for Takeuchi pts included baffle leaks in 6/21 pts who underwent postoperative echocardiogram, supravalvar pulmonary stenosis in 13/20 pts for whom followup is known (&lt; 25 mmHg in 9 pts, 26-50 mmHg in 2 pts, &gt; 50 mmHg in 2 pts requiring reoperation), and progressive aortic regurgitation requiring aortic valve replacement in 1 pt. There were no complications in the two modified Takeuchi pts (6 and 12 mos followup) or in reimplantation pts. (1) The degree of LV dysfunction at presentation does not predict survival in pts &lt; 1yr old, (2) current operative survival for ALCAPA does not justify consideration of transplantation, (3) LVAD may improve survival for some patients and should be available for postoperative management, and (4) supravalvar pulmonary stenosis occurs in a majority of Takeuchi pts, some of whom require reoperation; a modified technique may improve this postoperative complication rate.