title: Myocardial scarring after repair of anomalous origin of the left coronary artery from pulmonary artery.
abstract: OBJECTIVE
  Prognosis of patients with anomalous origin of the left coronary artery from pulmonary artery has dramatically improved as a result of both, early diagnosis and improvements in surgical techniques. Post surgical complications are rare and most patients show quick improvement of the left ventricular performance after repair with complete functional recovery within one year after surgery. Exercise-induced electrocardiographic changes have been found in patients postoperatively and scars and perfusion deficits of the left ventricle may not be detected by standard echocardiographic evaluation.
  
  
  METHODS
  Authors present 6 cases of anomalous origin of the left coronary artery from pulmonary artery observed at Martin Univesity Hospital and Pediatric Cardiology Clinic over the last eight-year period. In order to assess the presence of myocardial injury, cardiovascular magnetic resonance imaging with late gadolinium enhancement technique was performed in all 6 cases one year after surgical correction.
  
  
  RESULTS
  One patient died 1.5 year after surgical treatment. One year after surgery, the heart size and myocardial functions returned to normal in all patients. Cardiovascular magnetic resonance imaging demonstrated subendocardial late gadolinium enhancement in varios segments of the left ventricle, representing myocardial fibrosis in all patients one year after surgical correction.
  
  
  CONCLUSIONS
  Because of the presence of scarr tissue, the long term prognosis of these patients remains unclear. The damaged tissue may have arrhythmogenic potential, therefore close follow-up, excercise testing and avoidance of high-level sport activities may be needed.
authors.affiliation: Pediatric Cardiology Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Jurko
authors.affiliation: Radiology Clinic, Medical Faculty, Comenius University in Bratislava, Bratislava, Slovakia.
authors.forename: Jana
authors.initials: J
authors.lastname: Mistinova Polakova
authors.affiliation: Pediatric Cardiology Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Jurko
authors.affiliation: Department of Neonatology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
authors.forename: Tomas
authors.initials: T
authors.lastname: Jurko
authors.affiliation: Department of Emergency Health Care, Faculty of Health Care, Catholic University in Ruzomberok, Ruzomberok, Slovakia.
authors.forename: Milan
authors.initials: M
authors.lastname: Minarik
authors.affiliation: Department of Physiology and Martin Centre for Biomedicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Tonhajzerova
mesh_terms: D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000473:pathology*; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005355:Fibrosis; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009206:Myocardium / Q000473:pathology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology*; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery*