title: Myocardial perfusion, scarring, and function in anomalous left coronary artery from the pulmonary artery syndrome: a long-term analysis using magnetic resonance imaging.
abstract: BACKGROUND
  Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect. We aimed to examine the role of cardiac magnetic resonance imaging (MRI) in the long-term surveillance of repaired ALCAPA with regard to myocardial scarring, wall motion abnormalities, perfusion deficits, and myocardial function.
  
  
  METHODS
  Twenty-one patients after direct reimplantation of ALCAPA (median age at operation, 2.8 years) were examined after a median 10.6 years by MRI at rest and under dobutamine stress conditions, echocardiography, and ergometry. Results were compared with preoperative, immediately postoperative (5 days), and intermediate-term (5.8 years) echocardiography.
  
  
  RESULTS
  No early or late deaths occurred. Improvements in indexed left ventricular end-diastolic dimension, ejection fraction, and mitral valve function were observed in all patients. However, MRI at rest showed wall motion abnormalities in 67% and perfusion deficits in 28%. Myocardial scars were seen in 67%. Dobutamine stress MRI detected wall motion abnormalities in 19% and perfusion deficits in 14%, which were not seen on MRI at rest. Exercise testing did not reflect cardiac dysfunction.
  
  
  CONCLUSIONS
  Although long-term follow-up showed global left ventricular function had improved after ALCAPA repair, MRI showed left ventricular wall motion abnormalities, perfusion deficits, and myocardial scarring were seen in many patients. Dobutamine stress MRI identified deficits that were not evident on MRI at rest, and can therefore be considered a valuable surveillance tool. These results suggest the need for lifelong surveillance of repaired ALCAPA.
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany. Electronic address: schmitt@dhzb.de.
authors.forename: Boris
authors.initials: B
authors.lastname: Schmitt
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany.
authors.forename: Sina
authors.initials: S
authors.lastname: Bauer
authors.affiliation: Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, Nebraska.
authors.forename: Shelby
authors.initials: S
authors.lastname: Kutty
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Nordmeyer
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Nasseri
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Alexi-Meskishvili
mesh_terms: D002648:Child; D002675:Child, Preschool; D003326:Coronary Circulation; D003330:Coronary Vessel Anomalies / Q000503:physiopathology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology; D009200:Myocardial Contraction; D011651:Pulmonary Artery / Q000002:abnormalities*; D016277:Ventricular Function, Left / Q000502:physiology*