title: Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants.
abstract: OBJECTIVE
  Anatomical repair seems an ideal method for the surgical treatment of the anomalous left coronary artery arising from the pulmonary artery (ALCAPA) in infancy. The medium-term outcome has been investigated for infants with ALCAPA following the restoration of a dual-coronary arterial circulation.
  
  
  METHODS
  Between April 1995 and July 2012, 23 infants with a median age of 4 months underwent surgical repair of ALCAPA in our department. Direct implantation of the anomalous coronary artery into the ascending aorta was feasible in 16 patients. A trap door flap method was used in 5 cases and a tubular extension technique in 2. No infant underwent mitral valve repair at the time of ALCAPA surgery. Left ventricular function and the degree of mitral valve regurgitation were assessed during a 10-year follow-up.
  
  
  RESULTS
  Four patients died in the early postoperative period, without independent predictors associated with this mortality. During follow-up, improvement in myocardial function occurred in all patients both early and late. There was only one improvement in severe mitral valve regurgitation. Subsequently, 2 children needed mitral valve replacement. There were no early or late reoperations of the reimplanted coronary arteries.
  
  
  CONCLUSIONS
  Aortic reimplantation is an effective surgical treatment for ALCAPA in infants burdened with a low risk of reoperation due to coronary artery stenosis. There was good potential for myocardial recovery within the first year after surgery. Restoration of the anatomical coronary circulation did not improve mitral valve function in infants with severe preoperative mitral incompetence.
authors: Department of Cardiosurgery, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland. kazmierczak_piotr@yahoo.com
authors: Piotr A
authors: PA
authors: Kazmierczak
authors: Katarzyna
authors: K
authors: Ostrowska
authors: Pawel
authors: P
authors: Dryzek
authors: Jadwiga A
authors: JA
authors: Moll
authors: Jacek J
authors: JJ
authors: Moll
mesh_terms: D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D003326:Coronary Circulation; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D011651:Pulmonary Artery / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation; D020127:Recovery of Function; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Congenital heart disease; Coronary artery anomaly; Infant; Mitral valve regurgitation