title: Speckle Tracking in ALCAPA Patients After Surgical Repair as Predictor of Residual Coronary Disease.
abstract: Surgical re-implantation of the left coronary artery (LCA) is the treatment of choice in anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Despite normalization of left ventricular function after surgery, residual coronary lesions or myocardial fibrosis may be found. The aim of this study was to detect regional left ventricular dysfunction predictive of coronary lesions or residual myocardial fibrosis using speckle tracking. We enrolled ten patients treated with surgical re-implantation of LCA for ALCAPA. All patients were asymptomatic, and ejection fraction (EF) was normal. Using S-SR imaging, we studied longitudinal, radial, and circumferential function. A cardiac MRI was performed to assess myocardial fibrosis and the anatomy of the coronaries. In case of suspected coronary stenosis, a coronary angiography was performed. Finally, 20 normal subjects were enrolled as control group. Median age at surgery was 188 days, and mean follow-up was 8.7 ± 4.7 years. Longitudinal and circumferential functions were reduced in LCA territory compared to RCA territory and normal. MRI showed LCA stenosis in three of ten patients, confirmed by coronary angiography: these patients had the lowest longitudinal strain values in LCA territories (-11.7, -14.7 and -14.8%). Radial strain was preserved (Normal 45.6 ± 12.1, ALCAPA 43.5 ± 10.7%, p = ns), while circumferential strain was mildly depressed (-23.5 ± 3.8 vs. -20.3 ± 2.0%, p < 0.05). After LCA re-implantation, ALCAPA patients showed a residual sub-endocardial damage in LCA territories. Despite a normal systolic and diastolic function, the prevalence of residual coronary lesions was high. A mean longitudinal strain >-15% in LCA territories was able to identify those patients.
authors.affiliation: Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, via Giustiniani 3, 35128, Padua, Italy. b.castaldi@yahoo.it.
authors.forename: Biagio
authors.identifier: http://orcid.org/0000-0001-8140-6798
authors.initials: B
authors.lastname: Castaldi
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Vladimiro
authors.initials: V
authors.lastname: Vida
authors.affiliation: Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, via Giustiniani 3, 35128, Padua, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Reffo
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Padalino
authors.affiliation: Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, via Giustiniani 3, 35128, Padua, Italy.
authors.forename: Queenette
authors.initials: Q
authors.lastname: Daniels
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stellin
authors.affiliation: Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, via Giustiniani 3, 35128, Padua, Italy.
authors.forename: Ornella
authors.initials: O
authors.lastname: Milanesi
mesh_terms: D063748:Bland White Garland Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D004452:Echocardiography; D005355:Fibrosis; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D009206:Myocardium / Q000473:pathology; D014656:Vascular Surgical Procedures; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
keywords: Bland white garland syndrome; Myocardium; Phantoms imaging; Thoracic surgical procedures