title: Outcomes of coronary transfer for anomalous origin of the left coronary artery from the pulmonary artery.
abstract: OBJECTIVE
  To determine outcomes of patients presenting with an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) who underwent coronary transfer, and to investigate the role of the left ventricular ejection fraction (LVEF) and preoperative myocardial viability as the predictors for incomplete LV functional recovery.
  
  
  METHODS
  From 2002 to 2012, 40 consecutive patients whose diagnosis was ALCAPA and who underwent coronary transfer were included. Seventeen patients (42.5%, 17/40) presented with LV dysfunction (Group I) while the other 23 (57.5%, 23/40) did not (Group II). All patients in Group I underwent myocardial perfusion/metabolism imaging and the global viability index was calculated. The mean follow-up time was 54 ± 37 months.
  
  
  RESULTS
  The median age at repair was 27.6 months (range, 3-66 months) and the mean preoperative LVEF was 49.0 ± 15.6%. Two extracorporeal membrane oxygenation support systems were required after correction. There were no in-hospital deaths and 1 late death. The mean LVEF was significantly improved to 61.0 ± 12.2 and 64.0 ± 11.2% at discharge and follow-up, respectively. Both the LVEF at discharge (52.7 ± 17.1% in Group I versus 66.1 ± 8.0% in Group II, P = 0.02) and the LVEF at the latest follow-up (55.2 ± 10.1% in Group I versus 67.6 ± 8.0% in Group II, P = 0.03) were lower in Group I than Group II. Moderate mitral regurgitations (MRs) were noted in 5 patients (12.8%, 5/39) at follow-up without difference between groups. Restrained functional recovery was observed in 6 patients (35.2%, 6/17) in Group I and the global viability index (P = 0.02) was identified as a predictor for incomplete LV functional recovery.
  
  
  CONCLUSIONS
  Coronary transfer is a technique of choice with favourable outcomes for this anomaly. In the majority of patients, both ventricular function and MR tend to be normalized over time. Myocardial viability may be an alternative predictor for restrained LV functional recovery.
authors.affiliation: Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Ma
authors.affiliation: Centre for Pharmacology and Therapeutics, Experimental Medicine, Imperial College London, London, UK.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Zhongdong
authors.initials: Z
authors.lastname: Hua
authors.affiliation: Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Keming
authors.initials: K
authors.lastname: Yang
authors.affiliation: Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Shengshou
authors.initials: S
authors.lastname: Hu
authors.affiliation: Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yan
authors.affiliation: Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Xiangbin
authors.initials: X
authors.lastname: Pan
authors.affiliation: Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China drlishoujun@yahoo.com.
authors.forename: Shoujun
authors.initials: S
authors.lastname: Li
authors.affiliation: Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Qiuming
authors.initials: Q
authors.lastname: Chen
mesh_terms: D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006321:Heart / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Anomalous origin of coronary artery; Congenital heart disease; Coronary artery transfer; Left ventricular function; Myocardial viability