title: Very early correction of anomalous left coronary artery from the pulmonary artery improves intensive care management.
abstract: BACKGROUND
  Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) can sometimes be diagnosed very early in newborns and thus be corrected surgically before any myocardial ischaemia occurs.
  
  
  OBJECTIVE
  To evaluate the influence of this very early surgery on intensive care management and long-term outcome.
  
  
  METHODS
  All children operated on for ALCAPA before the age of 1 year between 1995 and 2010 were considered. Those operated on before the onset of ischaemia (group B) were compared with a matched group of children of similar weight who were operated on by the same surgeon on a close surgery date (group A).
  
  
  RESULTS
  We obtained a homogenous population of 13 children (eight in group A; five in group B) with no significant weight difference between groups. The surgical technique and peroperative variables were similar in both groups. There was one death in each group. The group B death was due to postoperative occurrence of global myocardial infarction despite correct surgical reparation. Mechanical ventilation duration, inotropic support duration, intensive care duration and long-term complications were lower in group B.
  
  
  CONCLUSIONS
  Very early ALCAPA surgical correction before occurrence of ischaemia must be encouraged whenever possible because it simplifies intensive care management and prevents persistent mitral regurgitation, but it does not reduce peroperative risk.
authors.affiliation: Service de cardiologie infantile, CHU Nancy-Brabois, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France. l.bonnemains@chu-nancy.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Bonnemains
authors.forename: Virginie
authors.initials: V
authors.lastname: Lambert
authors.forename: Anne
authors.initials: A
authors.lastname: Moulin-Zinch
authors.forename: Dany
authors.initials: D
authors.lastname: Youssef
authors.forename: Alain
authors.initials: A
authors.lastname: Serraf
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003422:Critical Care; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000517:prevention & control; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery*; D012092:Replantation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents