title: Cardiovascular magnetic resonance assessment of ventricular function and myocardial scarring before and early after repair of anomalous left coronary artery from the pulmonary artery.
abstract: BACKGROUND
  In patients with anomalous left coronary artery from the pulmonary artery (ALCAPA) left ventricular (LV) dilatation and dysfunction evolves due to diminished myocardial perfusion caused by coronary steal phenomenon. Using late gadolinium enhanced cardiovascular magnetic resonance (LGE-CMR) imaging, myocardial scarring has been shown in ALCAPA patients late after repair, however the incidence of scarring before surgery and its impact on postoperative course after surgical repair remained unknown.
  
  
  METHODS
  8 ALCAPA-patients (mean age 10.0 ± 5.8 months) underwent CMR before and early after (mean 4.9 ± 2.5 months) coronary reimplantation procedures. CMR included functional analysis and LGE for detection of myocardial scars.
  
  
  RESULTS
  LV dilatation (mean LVEDVI 171 ± 94 ml/m2) and dysfunction (mean LV-EF 22 ± 10 %) was present in all patients and improved significantly after surgery (mean LVEDV 68 ± 42 ml/m2, p=0.02; mean LV-EF 58 ± 19 %, p<0.001). Preoperative CMR revealed myocardial scarring in 2 of the 8 patients and did not predict postoperative course. At follow-up CMR, one LGE-positive patient showed delayed recovery of LV function while myocardial scarring was still present in both patients. In two patients new-onset transmural scarring was found, although functional recovery after operation was sufficient. One of them showed a stenosis of the left coronary artery and required resurgery.
  
  
  CONCLUSIONS
  Despite diminished myocardial perfusion and severely compromised LV function, myocardial scarring was preoperatively only infrequently present. Improvement of myocardial function was independent of new-onset scarring while the impact of preoperative scarring still needs to be defined.
authors.affiliation: Pediatric Heart Center, University Children's Hospital, Giessen, Germany. heiner.latus@googlemail.com.
authors.forename: Heiner
authors.initials: H
authors.lastname: Latus
authors.forename: Kerstin
authors.initials: K
authors.lastname: Gummel
authors.forename: Stefan
authors.initials: S
authors.lastname: Rupp
authors.forename: Matthias
authors.initials: M
authors.lastname: Mueller
authors.forename: Christian
authors.initials: C
authors.lastname: Jux
authors.forename: Gunter
authors.initials: G
authors.lastname: Kerst
authors.forename: Hakan
authors.initials: H
authors.lastname: Akintuerk
authors.forename: Juergen
authors.initials: J
authors.lastname: Bauer
authors.forename: Dietmar
authors.initials: D
authors.lastname: Schranz
authors.forename: Christian
authors.initials: C
authors.lastname: Apitz
mesh_terms: D063748:Bland White Garland Syndrome / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling