[Results of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery].
OBJECTIVE
To evaluate effectiveness of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery.


METHODS
Between April 1999 and August 2005, 12 patients with anomalous origin of the coronary artery from the pulmonary artery underwent surgical correction. There were 8 patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), and 4 patients with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). Eight patients underwent direct aortic reimplantation, and 4 patients underwent a Takeuchi procedure (intrapulmonary artery baffle with an autologous pericardial patch). Simultaneous mitral annuloplasty was performed in 7 patients of ALCAPA with moderate and severe mitral regurgitation. One patient of ARCAPA was associated with an atrial septal defect (ASD) which was closed with an amplatzer septal occluder through right atrium under transesophageal echocardiography (TEE) without CPB.


RESULTS
There were neither early and late deaths nor postoperative complications. Follow-up of all patients ranged from 7 to 83 months (mean, 32 +/- 24 months). The left ventricular function after operation improved from a preoperative fractional shortening (FS) of 0.21 +/- 0.09 to 0.35 +/- 0.06 (P = 0.006) for patients with ALCAPA. Preoperative mitral regurgitation decreased in 7 patients of ALCAPA after mitral annuloplasty at the follow-up. All patients were doing well and their exercise tolerance improved to normal. They were free from symptoms.


CONCLUSIONS
Reestablishment of a two-coronary system is necessary for patients with anomalous origin of the coronary artery from the pulmonary artery. The left ventricular function improved after 2-coronary repair. We recommend that the simultaneous mitral annuloplasty should be performed at the time of operation for patients who have moderate and severe mitral regurgitation with ALCAPA. Surgical correction of ARCAPA and ARCAPA show good early and mid-term results, long-term results need to be followed up.
Xu
Jian-ping
JP
Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Guo
Hong-wei
HW
Hu
Sheng-shou
SS
Sun
Li-zhong
LZ
Song
Yun-hu
YH
Sun
Han-song
HS
D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome