Surgical Treatment Of Anomalous Origin Research Articles

Surgical Treatment for Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in a Patient with Rheumatic Heart Disease: A Case Report and Literature Review

Surgical Treatment for Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in a Patient with Rheumatic Heart Disease: A Case Report and Literature Review

A Case of Surgical Treatment of Anomalous Origin of the Single Coronary Artery from the Pulmonary Artery

A Case of Surgical Treatment of Anomalous Origin of the Single Coronary Artery from the Pulmonary Artery

Surgical treatment for anomalous origin of the right coronary artery from the pulmonary artery: a case report with five-year follow-up

BackgroundAnomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital heart disease affecting about 0.002% of the population. Knowledge of ARCAPA is almost collected from case reports. The aim of this study was to provide a rare case to better understand this rare congenital coronary anomaly.Case presentationWe report a rare case of an 18-year-old male who was initially referred because of heart murmur. Dilated and tortuous coronary arteries were detected by echocardiography and congenital coronary anomaly was suggested. Further coronary CT angiography confirmed the diagnosis of ARCAPA. Although dual coronary system provides favorable long-term outcome, bypass surgery was considered technically difficult due to the huge mismatch of caliber between the right coronary artery and graft vessels. Eventually, simple right coronary artery ligation was performed. The patient was followed up for about 5 years without evidence of atherosclerosis or myocardial ischemia.ConclusionsARCAPA presents as a rare congenital heart disease with variable clinical manifestations. Surgical treatment is highly recommended to re-establish dual coronary system and prevent further complications. To our best knowledge, only about 200 cases of ARCAPA has been reported.

Coronary Bypass With the Free Internal Thoracic Artery to Treat Anomalous Right Coronary Artery

The surgical treatment of anomalous origin of the coronary artery remains controversial. We present 3 cases of young adults who underwent free right internal thoracic artery to right coronary artery bypass for the treatment of symptomatic anomalous origin of the right coronary artery.

The surgical treatment of anomalous origin of one pulmonary artery from the ascending aorta

ObjectiveThis study sought to summarize the clinical experience of surgical treatment of anomalous origin of pulmonary arteries from the ascending aorta (AOPA) in Fuwai hospital.MethodsFifty-two patients (28 males, 17.2 ± 27.2 months old and 8.7 ± 10.2 Kg weight) who have AOPA undertook surgical treatment between 1998 and 2017 were reviewed in this study, 47 out of 52 are anomalous origin of the right pulmonary artery (AORPA), among the rest of the patients are anomalous origin of left pulmonary artery (AOLPA). 27 out of 52 associate with simple cardiac abnormalities, 20 out of 52 associate with complex cardiac malformations, the remaining 5 patients without cardiac abnormalities. Among all patients who underwent surgical treatment, the direct end-to-side anastomosis strategy was applied in 26 patients, autologous pericardial-homograft patch and aortic flap were employed in 20 patients, and synthetic graft was used in 6 patients.ResultsNo patient died during the perioperative period. 50 out of 52 patients were followed-up for 100.1 ± 70.9 months. The rate of pulmonary arterial free restenosis for 2 years, 5 years, and 10 years is 98.0, 96.0 and 92.0%, respectively.ConclusionsThe correct diagnosis and appropriate surgical treatment for AOPA could obtain excellent early and medium-term result.

Improvement of the Ischemic Area after Surgical Treatment for Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery

Improvement of the Ischemic Area after Surgical Treatment for Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery

Off-Pump Surgical Treatment of Anomalous Origin of the Left coronary Artery from the Pulmonary Artery

An anomalous origin of the left coronary artery from the pulmonary artery, or Blund – White – Garland syndrome, is a rare congenital heart disease in which an anatomically correctly formed left coronary artery extends away from the pulmonary artery. Most patients with this defect die from progressive left ventricular failure during the first year of life, and the rest may suddenly die in adolescence or adulthood from acute coronary insufficiency. Several surgical methods of correction of the defect have been proposed, but a small number of observations do not allow one to express unequivocally in favor of one of the methods of performing the operation. We present our own observation of a surgical correction of a defect in a teenager. We performed off-pump aortocoronary bypass surgery of the anterior interventricular artery, and separation of the left coronary artery from the pulmonary artery by ligation, with the stitching of the left coronary artery. The issue of the expediency of tying hypertrophied collaterals between right coronary artery and left coronary artery systems was discussed with the purpose of reducing competitive blood flow after performing left coronary artery shunting. Experience in performing coronary artery bypass surgery without artificial circulation made it possible to perform an off-pump operation.

Preoperative diagnosis and surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery

Objective To investigate the preoperative diagnosis, surgical treatment and results of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA). Methods We retrospectively analyzed the clinical data of 9 patients with ALCAPA who had undergone surgical treatment in Shanxi Children′s Hospital from June 2010 to March 2014. Results There were 3 males and 6 females, aged from 4 months to 4 years old and 6 months, average age(1.14±1.33)years, body weight from 5.6 to 18.0 kg, average weight(8.06±3.99) kg.Echocardiography and spiral CT angiography were performed in all patients, one of which underwent cardiac catheter angiography.The cases of mitral regurgitation were mild in 2 cases, mild to moderate in 5 cases, and moderate to severe in 2 cases.Electrocardiogram showed abnormal Q wave, ST segment change and T wave inversion in lead Ⅰ, AVL and V4-6 in 9 cases.The X-ray sign was significant heart enlargement(C/T ratio 0.56-0.73, mean 0.61±0.05). Echocardiography indicated ALCAPA, significant enlargement of left ventricle and decreased myocardial contractility(ejection fraction less than 50%). End diastolic diameter of left ventricle were more than 35 mm in 8 cases and aneurysm formation of left ventricular apex in 1 case.One case was confirmed ALCAPA by catheter angiography.Six cases had radioactive nuclide myocardial imaging, which showed different degree of myocardial infarction.All patients underwent reimplantation of left coronary artery into the aorta, mitral valvoplasty in 7 patients.One case died for low cardiac output syndrome.Others recovered and discharged.Postoperative complications included low cardiac output syndrome in 2 cases, pneumonia in 3 cases and supraventricular tachycardia in 1 case.During a follow-up of 3 months to 2 years, well development, good heart function, mitral valve regurgitation and ejection fraction improved in all case. Conclusion Echocardiography has important value in diagnosis of ALCAPA, which are confirmed by spiral CT angiography and catheter angiography.Preoperative nuclide examination for determinant of survival myocardium is helpful for surgery and prognosis.Reimplantation of left coronary artery into the aorta is the most ideal surgical procedure. Key words: Anomalous origin of the left coronary artery from the pulmonary artery; Preoperative diagnosis; Surgical treatment

Surgical Treatment of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in an Infant with Severe Ventricular Dysfunction

Anomalous origin of the left coronary artery from the pulmonary artery is a rare disease that may result in occasionally even death during the early infant. We present a successfully treated case of an 8-month-old boy with concomitant severe left ventricular dysfunction. Treatment consisted of simple patch closure to the left coronary artery from inside the pulmonary artery to avoid long duration of cardiopulmonary bypass.

症例 乳児左冠状動脈肺動脈起始症に対する根治手術 同種大伏在静脈による冠状動脈血行再建術

症例 乳児左冠状動脈肺動脈起始症に対する根治手術 同種大伏在静脈による冠状動脈血行再建術

Surgical Treatment of Anomalous Left Pulmonary Artery

We report our experience with the surgical treatment of anomalous origin of the left pulmonary artery in eight children between 2004 and 2009. The congenital heart disease most frequently associated with this condition was patent ductus arteriosus. Surgery was carried out with extracorporeal circulation in five children, and without, in three. The anomalous pulmonary artery was divided and translocated to the main pulmonary artery. One patient died soon after surgery because of hemodynamic instability and another died later because of respiratory complications. The other patients progressed satisfactorily during follow-up: the reimplanted artery remained patent in all cases and respiratory symptoms improved. However, one patient required endoscopic treatment.

Tratamiento quirúrgico del origen anómalo de la arteria pulmonar izquierda

We report our experience with the surgical treatment of anomalous origin of the left pulmonary artery in eight children between 2004 and 2009. The congenital heart disease most frequently associated with this condition was patent ductus arteriosus. Surgery was carried out with extracorporeal circulation in five children, and without, in three. The anomalous pulmonary artery was divided and translocated to the main pulmonary artery. One patient died soon after surgery because of hemodynamic instability and another died later because of respiratory complications. The other patients progressed satisfactorily during follow-up: the reimplanted artery remained patent in all cases and respiratory symptoms improved. However, one patient required endoscopic treatment. Full English text available from: www.revespcardiol.org

Suspicion, diagnosis, and successful surgical treatment of anomalous origin of the anterior descending coronary artery from the pulmonary trunk

Anomalous origin of the anterior descending coronary artery from the pulmonary trunk is very rare. We suspected such anomalous origin in a boy aged 2.5 years owing to the echocardiographic demonstration of mitral regurgitation and abnormal diastolic flow in the ventricular septum. The diagnosis was confirmed by angiography. The anomalous artery was successfully reimplanted into the aorta.

Surgical treatment of anomalous origin of coronary artery from the pulmonary artery

Anomalous origin of coronary artery from the pulmonary artery is a rare congenital cardiac malformation with a mortality rate of up to 90% within the first year of life without surgical intervention. Direct implantation of the anomalous coronary artery (ACA) into the aorta is successful in early life, but it may have increased surgical difficulty and risk with age. This retrospective study summarized our operative experience in direct implantation for treatment of this coronary anomaly in pediatric and adult patients. From August 2000 to January 2003, 4 consecutive patients aged from 9 months to 41 years underwent dual coronary repair. Among them, two children and one infant with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and one adult was anomalous origin of right coronary artery from the pulmonary artery (ARCAPA). Coronary arteries were directly implanted into the ascending aorta in 4 patients. In a boy with ALCAPA associated with moderate mitral insufficiency (MI), whose ACA arose remotely from the ascending aorta, we created a tube-shaped graft using part of the pulmonary arterial wall in continuity with the origin of the left coronary artery (LCA). Concomitant moderate MI was repaired in 2 patients, including this boy, after a dual-coronary repair. All patients survived. There were no hospital or late deaths and no major complications as well. Echocardiography revealed that the left ventricular (LV) function including LV end-diastolic dimension (EDD) and ejection fraction (EF) was markedly improved at hospital discharge. At 3 - 6 years follow-up after surgery all patients were asymptomatic and currently in NYHA class I. The best results are achieved with direct implantation of the ACA into the ascending aorta and simultaneous mitral valve repair if needed. Direct implantation is feasible in pediatric and adult patients with ALCAPA or ARCAPA including the coronary artery in a location remote from the ascending aorta. It is a good procedure to lengthen the ACA by creating a tube-shape graft using part of the pulmonary arterial wall in continuity with the origin of ACA.

Surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery: Late results evaluated with dobutamine stress gated single-photon emission computed tomography sestamibi study

In the present study the importance of the gated myocardial perfusion scan in the evaluation of the surgical results has been shown. It was possible to monitor progressive improvement in myocardial perfusion immediately after surgical treatment and 1 year after operation. In addition to echocardiography and cardiac catheterization, gated myocardial perfusion scan has proved to be an excellent method in the preoperative and postoperative evaluation of anomalous origin of left coronary artery because with this procedure can determine the severity and location of myocardial ischemia and the degree of ventricular dysfunction.

Surgical treatment of anomalous origin of the left coronary artery in infancy and childhood: Early and late results in 20 consecutive cases

From 1972 to September, 1979, 20 patients underwent transplantation of the anomalous left coronary artery to the aorta, either directly or via a graft. Correction of ischemia-induced mitral insufficiency was associated in eight patients and a postinfarction left ventricular scar was excised in 12. Operative mortality was high among patients under 1 year of age (4/5). Among older children it was 15%. There were not late deaths among patients surviving the operation (mean follow-up 3 years). All but one had marked clinical improvement and reduction of cardiomegaly. Eleven patients underwent angiographic control, with a patent graft or anastomosis demonstrated in every case. Operation is advocated for patients over 1 year of age. The best treatment of symptomatic infants remains controversial.

Surgical Treatment of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Associated with Tetralogy of Fallot

An 8-year-old boy with anomalous origin of the left coronary artery from the pulmonary artery associated with tetralogy of Fallot, which was definitely diagnosed preoperatively, was operated on with success. Direct implantation of the left coronary artery into the aorta following division of the left coronary artery from the pulmonary artery and, concomitantly, total repair for tetralogy of Fallot using an external valved conduit were performed. Postoperative cineangiogram revealed a hemodynamically well-repaired intracardiac condition and anterograde filling of the left coronary artery, compared with retrograde left coronary flow from intercoronary collateral vessels preoperatively. To the best of our knowledge, there is not a previously published report of anomalous origin of the left coronary artery from the pulmonary artery associated with tetralogy of Fallot that was treated surgically with success.

Correction of anomalous origin of the left coronary artery

Successful surgical treatment for anomalous origin of the left coronary artery from the pulmonary artery was performed in one patient by left coronary artery-subclavian anastomosis and in two patients by direct implantation of the left coronary artery into the aorta. The excellent early and late results obtained with these methods and the suboptimal results reported with saphenous vein grafting for this lesion make these other alternatives more attractive. Direct implantation of the left coronary artery into the aorta utilizing cardiopulmonary bypass and hypothermic (4 degrees C.) potassium-induced (20 mEq. per liter) cardioplegia is now our preferred approach for most patients with this lesion.

Hypertension secondary to a renin-producing juxtaglomerular cell tumor

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Definitive surgical treatment of anomalous origin of left coronary artery: A new technical approach used successfully in a seven-month-old male infant

Anomalous origin of left coronary artery from the pulmonary artery is a very rare cardiac anomaly. Most patients with this defect die in the first year of life. Reconstructive surgery of the left coronary artery is the only saving measure in the management of this disease. A radical operation was successfully carried out in a seven-month-old boy by interposing a homologous saphenous vein (from his mother) between the aorta and left coronary artery. The operation was performed by use of deep hypothermia with surface cooling combined with limited cardiopulmonary bypass. The postoperative clinical course was uneventful and the patient relatively asymptomatic. Postoperative coronary angiograms revealed that the interposed homologous vein graft was patent, although it was slightly stenotic. Following the operation the patient showed good development and growth and has now reached 2 years of age. The purpose of this paper is to present the case by discussing our new operative technique.