Anomalous origin of the left coronary artery from the pulmonary artery: mid-term results after surgical correction.
OBJECTIVE
Children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) are at risk for myocardial infarction and death. This retrospective study shows the mid-term follow-up after the use of aortic implantation and alternative methods to achieve coronary transfer.


METHODS
Since 1990 seven consecutive children underwent primary repair of ALCAPA. Age at operation ranged from 2 to 71 months (median 11 months). Operative techniques included ligation (n = 1), intrapulmonary tunnel (n = 1), and aortic implantation (n = 5). One patient with severe mitral valve incompetence underwent additional mitral valve replacement. A 4-month-old patient was successfully treated after the operation with a left heart assist device.


RESULTS
One death in the series occurred at 2 weeks after intrapulmonary tunneling. The mid-term results were evaluated in the six survivors with a follow-up mean of 98 months (ranged 58-168). In all surviving patients with two-vessel coronary blood supply, left ventricular end-diastolic volume and left ventricular ejection fraction returned to near normal values 2-12 months postoperatively. The mitral valve incompetence decreased in all patients with a native mitral valve. One patient with coronary ligation showed severe mitral valve regurgitation and received additional mitral valve replacement concomitantly. Six years after primary valve replacement of a 21 mm SJM (Saint Jude Medical) a change of the mechanical valve to a 27 mm valve was necessary because of development of severe stenosis due to growth.


CONCLUSIONS
It is always preferable to establish an antegrade flow of oxygenated blood through the coronary arteries and to create a two-coronary artery system. Mitral valve annuloplasty or replacement may be necessary for patients with severe mitral valve incompetence.
Kuroczynski
Wlodzimierz
W
Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University, Langenbeck-Str. 1, 55131 Mainz, Germany. kuroczynski@uni-mainz.de
Kampmann
Christoph
C
Kayhan
Nalan
N
Heinemann
Markus
M
Pruefer
Diethard
D
Vahl
Christian-Friedrich
CF
D001013:Aorta, Thoracic / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016276:Ventricular Function