title: An experience with off pump technique for repair of anomalous left coronary artery from pulmonary artery (ALCAPA).
abstract: BACKGROUND
  Anomalous origin of left coronary artery from pulmonary artery is a very rare disease with incidence of one every 300,000 live births. It has a high mortality of 80% in the first year of life. This observational study summarized our experience using the technique of subclavian arterial bypass without the use of cardiopulmonary bypass (CPB) for treatment of this coronary anomaly in pediatric population. The study aims to revive an earlier technique, with modifications, as an alternative to the existing coronary translocation.
  
  
  METHODS
  From 2009 till 2015, six consecutive infants were operated by a single surgeon using subclavian artery to left coronary artery bypass done off pump, to establish a two coronary circulation.
  
  
  RESULTS
  Five patients had an improvement in their LV ejection fractions at the time of the last follow-up. Angiography done in two cases after 2 and 6 years after surgery revealed good flow in the left coronary artery and good growth in the length of subclavian artery. There was one surgical mortality in this series.
  
  
  CONCLUSIONS
  The technique of off pump subclavian arterial bypass for anomalous origin of the left coronary artery from the pulmonary artery is a viable alternative to the existing standard technique of coronary translocation. It essentially eliminates extracorporeal circulatory support or a left heart bypass that may be needed after coronary translocation. Also, the advantage of avoiding CPB, both in economic terms and also the adverse effects related to use of bypass in this very sick hearts, cannot be disregarded.
authors: Department of Pediatric and Congenital Heart Centre, New Age Wockhardt Hospital, Mumbai, India.
authors: Suresh
authors: S
authors: V Joshi
authors: Department of Pediatric and Congenital Heart Centre, New Age Wockhardt Hospital, Mumbai, India. Electronic address: abhijeet_avian@yahoo.co.in.
authors: Abhijeet
authors: A
authors: V Naik
authors: Department of Pediatric and Congenital Heart Centre, New Age Wockhardt Hospital, Mumbai, India.
authors: Parag
authors: P
authors: S Bhalgat
authors: Department of Pediatric and Congenital Heart Centre, New Age Wockhardt Hospital, Mumbai, India.
authors: Bhushan
authors: B
authors: Chavan
authors: Department of Pediatric and Congenital Heart Centre, New Age Wockhardt Hospital, Mumbai, India.
authors: Prasanna
authors: P
authors: Salvi
mesh_terms: D063748:Bland White Garland Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: ALCAPA; Off pump; Subclavian bypass