title: Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection (ALCAPA).
abstract: BACKGROUND
  Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly. This study shows the role of cardiovascular magnetic resonance (CMR) in assessing young patients following surgical repair of ALCAPA.
  
  
  METHODS
  6 patients, aged 9-21 years, with repaired ALCAPA (2 Tackeuchi method, 4 direct re-implantation) underwent CMR because of clinical suspicion of myocardial ischemia. Imaging used short and long axis cine images (assess ventricular function), late-gadolinium enhancement (LGE) (detect segmental myocardial fibrosis), adenosine stress perfusion (detect reversible ischaemia) and 3D whole-heart imaging (visualize proximal coronary arteries).
  
  
  RESULTS
  The left ventricular (LV) global systolic function was preserved in all patients (mean LV ejection fraction = 62.7% ± 4.23%). The LV volumes were within the normal ranges, (mean indexed LVEDV = 75.4 ± 3.5 ml/m², LVESV = 31.6 ± 9.4 ml/m²). In 1 patient, hypokinesia of the anterior segments was visualized. Five patients showed sub-endocardial LGE involving the basal, antero-lateral wall and the anterior papillary muscle. Three patients had areas of reversible ischemia. In these 3, 3D whole-heart MRA showed that the proximal course of the left coronary artery was occluded (confirmed with cardiac catheterisation).
  
  
  CONCLUSIONS
  CMR is a good, non-invasive, radiation-free investigation in the post-surgical evaluation of ALCAPA. In referred patients we show that basal, antero-lateral sub-endocardial myocardial fibrosis is a characteristic finding. Furthermore, stress adenosine CMR perfusion, can identify reversible ischemia in this group, and was indicative of left coronary artery occlusion.
authors.affiliation: Cardiorespiratory Unit, UCL Institute of Cardiovascular Sciences & Great Ormond Street Hospital for Children, London, UK.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Secinaro
authors.forename: Hopewell
authors.initials: H
authors.lastname: Ntsinjana
authors.forename: Oliver
authors.initials: O
authors.lastname: Tann
authors.forename: Pia K
authors.initials: PK
authors.lastname: Schuler
authors.forename: Vivek
authors.initials: V
authors.lastname: Muthurangu
authors.forename: Marina
authors.initials: M
authors.lastname: Hughes
authors.forename: Victor
authors.initials: V
authors.lastname: Tsang
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D003287:Contrast Media; D003326:Coronary Circulation; D003330:Coronary Vessel Anomalies / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008536:Meglumine; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009206:Myocardium / Q000473:pathology; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D012092:Replantation / Q000009:adverse effects; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine