title: Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children.
abstract: OBJECTIVE
  Although mortality after direct aortic reimplantation for anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) has significantly decreased, many questions remain unanswered.
  
  
  METHODS
  Between 1986 and June 2010, we operated on 27 consecutive pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). All patients underwent reestablishment of a dual coronary system with direct aortic reimplantation of the left coronary artery into the aorta. Postoperative extracorporeal mechanical circulatory support was necessary in 7 cases. In all 7 patients, hemodynamic stability was achieved after 4 to 10 days of support. Mitral valve repair was performed in 9 patients with severe mitral valve incompetence and resulted in stable mitral valve function during follow-up as long as 19 years.
  
  
  RESULTS
  There were no early or late deaths. During follow-up (3 months-17.5 years), both early and late improvement of myocardial function was observed in all patients. Reduced left ventricular regional function late after successful surgical correction of ALCAPA was related to the presence of left ventricular myocardial scar tissue, as detected by magnetic resonance imaging.
  
  
  CONCLUSIONS
  Despite the absence of early and late mortality, the long-term prognosis for patients after reimplantation of ALCAPA into the aorta is not clear. Scars and perfusion deficits of the left ventricle may not be detected by standard echocardiographic evaluation of global left ventricular function and therefore may be underestimated. We therefore recommend lifelong surveillance of these patients, including magnetic resonance imaging.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. alexi@dhzb.de
authors.forename: Vladimir
authors.initials: V
authors.lastname: Alexi-Meskishvili
authors.forename: Boris A
authors.initials: BA
authors.lastname: Nasseri
authors.forename: Sarah
authors.initials: S
authors.lastname: Nordmeyer
authors.forename: Boris
authors.initials: B
authors.lastname: Schmitt
authors.forename: Yu-Guo
authors.initials: YG
authors.lastname: Weng
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Böttcher
authors.forename: Michael
authors.initials: M
authors.lastname: Hübler
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D001011:Aorta / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003326:Coronary Circulation; D003330:Coronary Vessel Anomalies / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005858:Germany; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D058386:Mitral Valve Annuloplasty; D011651:Pulmonary Artery / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D012092:Replantation; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left