title: Anomalous origin of the left coronary artery from the pulmonary artery associated with severe left ventricular dysfunction: results in normothermia.
abstract: BACKGROUND
  Repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) carries a high risk of operation, particularly in those with poor left ventricular function. In this study, we assessed the outcomes of patients who presented with severe preoperative left ventricular dysfunction (shortening fraction <15%) who underwent the repair under normothermic bypass.
  
  
  METHODS
  Since September 2002, 21 infants with severe left ventricular dysfunction underwent surgical repair using a direct coronary reimplantation technique. Mean age of patients was 5.3 +/- 3.8 months. Moderate or severe mitral regurgitation present in 5 patients was not addressed at the operation. Repair was performed under normothermic cardiopulmonary bypass and myocardial protection was achieved by intermittent antegrade normothermic blood cardioplegia.
  
  
  RESULTS
  Mean cardiopulmonary bypass and cross-clamp times were 153.5 +/- 51 and 50 +/- 14.5 minutes, respectively. There was one (4.7%) early death because of sudden cardiac arrest 48 hours after successful weaning from mechanical ventilation. One patient required urgent left coronary artery stenting on the 34th postoperative day because of early reimplantation failure. There was no late death. Echocardiographic evaluation revealed a significant improvement in terms of shortening fraction (preoperative, 10.3 +/- 3.2% vs follow-up, 33 +/- 7.7%, p < 0.0001).
  
  
  CONCLUSIONS
  Our results suggest that the repair of anomalous origin of the left coronary artery from the pulmonary artery can be accomplished with acceptable mortality and morbidity rates even in patients having severely depressed left ventricular function. Normothermic cardiopulmonary bypass is safe and effective in children who have a limited tolerance to further ischemic insult.
authors: Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, University Paris-Sud, Le Plessis-Robinson, France. e.belli@ccml.fr
authors: Emre
authors: E
authors: Belli
authors: Régine
authors: R
authors: Roussin
authors: Mohammed
authors: M
authors: Ly
authors: François
authors: F
authors: Roubertie
authors: Emmanuel
authors: E
authors: Le Bret
authors: Murat
authors: M
authors: Basaran
authors: Alain
authors: A
authors: Serraf
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000601:surgery*; D006324:Heart Arrest, Induced; D006801:Humans; D007223:Infant; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications*