nach oben

Erschienen in:

01.04.2008 | ORIGINAL PAPER

Anomalous origin of the left coronary artery from the pulmonary artery: mid-term results after surgical correction

verfasst von: Wlodzimierz Kuroczynski, MD, Christoph Kampmann, MD, Nalan Kayhan, MD, Markus Heinemann, MD, Diethard Pruefer, MD, Christian-Friedrich Vahl, MD

Erschienen in: Clinical Research in Cardiology | Ausgabe 4/2008

Einloggen, um Zugang zu erhalten

Abstract

Objectives

Children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) are at risk for myocardial infarction and death. This retrospective study shows the mid-term follow-up after the use of aortic implantation and alternative methods to achieve coronary transfer.

Methods

Since 1990 seven consecutive children underwent primary repair of ALCAPA. Age at operation ranged from 2 to 71 months (median 11 months). Operative techniques included ligation (n = 1), intrapulmonary tunnel (n = 1), and aortic implantation (n = 5). One patient with severe mitral valve incompetence underwent additional mitral valve replacement. A 4-month-old patient was successfully treated after the operation with a left heart assist device.

Results

One death in the series occurred at 2 weeks after intrapulmonary tunneling. The mid-term results were evaluated in the six survivors with a follow-up mean of 98 months (ranged 58–168). In all surviving patients with two-vessel coronary blood supply, left ventricular end-diastolic volume and left ventricular ejection fraction returned to near normal values 2–12 months postoperatively. The mitral valve incompetence decreased in all patients with a native mitral valve. One patient with coronary ligation showed severe mitral valve regurgitation and received additional mitral valve replacement concomitantly. Six years after primary valve replacement of a 21 mm SJM (Saint Jude Medical) a change of the mechanical valve to a 27 mm valve was necessary because of development of severe stenosis due to growth.

Conclusions

It is always preferable to establish an antegrade flow of oxygenated blood through the coronary arteries and to create a two-coronary artery system. Mitral valve annuloplasty or replacement may be necessary for patients with severe mitral valve incompetence.

Alexi-Meskishvili V, Hetzer R, Weng Y, Lange PE, Ishino K (1994) Anomalous origin of the left coronary artery from the pulmonary artery. Early results with direct aortic reimplantation. J Thorac Cardiovasc Surg 108:354–362PubMed

Ando M, Mee RBB, Duncan BW, Drummond-Webb JJ, Seshadri SG, Mesia CI (2002) Creation of a dual-coronary system for anomalous origin of the left coronary artery from the pulmonary artery utilizing the trapdoor flap method. Eur J Cardio Thorac Surg 22:576–581CrossRef

Augustsson MH, Gasul BM, Fell EH, Graetinger JS, Bicoff JP, Waterman DF (1962) Anomalous origin of the left coronary artery from pulmonary artery: diagnosis and treatment of infantile and adult types. JAMA 180:15–21

Backer CL, Stout MJ, Zales VR, Muster AJ, Weigel TJ, Idriss FS, Mavroudis C (1992) Anomalous origin of the left coronary artery. A twenty-year review of surgical management. J Thorac Cardiovasc Surg 103:1049–1058PubMed

Berdijs F, Takahashi M, Wells WJ, Stiles QR, Lindesmith GG (1994) Anomalous left coronary artery from the pulmonary artery. J Thorac Cardiovasc Surg 108:17–20

Bland EF, White PD, Garland J (1933) Congenital anomalies of the coronary arteries: report of an unusual case associated with cardiac hypertrophy. Am Heart J 8:787–801CrossRef

Brueck M, Bandorski D, Vogt PR, Kramer W, Heidt MC (2006) Myocardial ischemia due to an isolated coronary fistula. Clin Res Cardiol 95:550–553PubMedCrossRef

Cochrane AD, Goh TH, Austin C, Karl TR (1999) Incipient left ventricularrupture complicating anomalous left coronary artery. Ann Thorac Surg 67:254–256PubMedCrossRef

Cochrane AD, Coleman DM, Davis AM, Brizard CP, Wolfe R, Karl TR (1999) Excellent long-term functional outcome after an operation for anomalous left coronary artery from the pulmonary artery. J Thorac Cardiovasc Surg 117:332–342PubMedCrossRef

10.

Cooley DA, Hallman GL, Bloodwell RD (1966) Definitive surgical treatment of anomalous origin of left coronary artery from pulmonary artery: indications and results. J Thorac Cardiovasc Surg 52:798–808PubMed

11.

Emmel M, Sreeram N, Pillekamp F, Boehm W, Brockmeier K (2006) Transhepatic approach for catheter interventions in infants and children with congenital heart disease. Clin Res Cardiol 95:329–333PubMedCrossRef

12.

Greil GF, Wolf I, Kuettner A, Fenchel M, Miller S, Martirosian P, Schick F, Oppitz M, Meinzer H-P, Sieverding L (2007) Stereolithographic reproduction of complex cardiac morphology based on high spatial resolution imaging. Clin Res Cardiol 96:176–185PubMedCrossRef

13.

Huddleston ChB, Balzer DT, Mendeloff EN (2001) Repair of anomalous left main coronary artery arising from the pulmonary artery in infants: long-term impact on the mitral valve. Ann Thorac Surg 71:1985–1989PubMedCrossRef

14.

Jin Z, Berger F, Uhlemann F, Schröder C, Hetzer R, Alexi-Meskishvili V, Weng Y, Lange PE (1994) Improvement in left ventricular dysfunction after aortic reimplantation in 11 consecutive paediatric patients with anomalous origin of the left coronary artery from the pulmonary artery. Early results of a serial echocardiographic follow-up. Eur Heart J 15:1044–1049PubMed

15.

Kesler KA, Pennington DG, Nouri S, Boegner E, Kanter KR, Harvey L, Chen SC, Juriedini S, Balfour I, Willman VL (1989) Left subclavian-left coronary artery anastomosis for anomalous origin of the left coronary artery. Long-term follow-up. J Thorac Cardiovasc Surg 98:25–29PubMed

16.

König K, Will JC, Berger F, Müller D, Benson DW (2006) Familial congenital heart disease, progressive atrioventricular block and the cardiac homeobox transcription factor gene NKX2.5. Clin Res Cardiol 95:499–503PubMedCrossRef

17.

Lange R, Vogt M, Hörer J, Cleuziou J, Menzel A, Holper K, Hess J, Schreiber C (2007) Long-term results of repair of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 83:1463–1471PubMedCrossRef

18.

Liberthson RR, Sagar K, Berkoben JP, Weintraub RM, Levine FH (1979) Congenital coronary arteriovenous fistula: report of 13 patients, review of literature and delineation of management. Circulation 59:849–854PubMed

19.

Neches WH, Mathews RA, Park SC, Lenox CC, Zuberbuhler JR, Siewers RD, Bahnson HT (1974) Anomalous origin of the left coronary artery from the pulmonary artery. A new method of surgical repair. Circulation 50:582–587PubMed

20.

del Nido PJ, Duncan BW, Mayer JE Jr, Wessel DL, LaPierre RA, Jonas RA (1999) Left ventricular assist device improves survival in children with left ventricular dysfunction after repair of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 67:169–172PubMedCrossRef

21.

Norozi K, Wessel A, Buchhorn R, Alpers V, Arnold JO, Zoege M, Geyer S (2007) Is the ABILITY index superior to the NYHA classification for assessing heart failure? Clin Res Cardiol 96:542–547PubMedCrossRef

22.

Pandey R, Ciotti G, Pozzi M (2002) Anomalous origin of the left coronary artery from the pulmonary artery: results of surgical correction in five infants. Ann Thorac Surg 74:1625–1630PubMedCrossRef

23.

Pozzi M, Santoro G, Makundan S (1998) Intraaortic balloon pump after treatment of anomalous origin of left coronary artery. Ann Thorac Surg 65:555–557PubMedCrossRef

24.

Sabiston DC Jr, Neil CA, Taussig HB (1960) The direction of blood flow in anomalous left coronary artery arising from the pulmonary artery. Circulation 2:591–597

25.

El Said GM, Ruzyllo W, Williams RL, Mullins CE, Hallman GL, Cooley DA, McNamara DG (1973) Early and late result of saphenous vein graft for anomalous origin of left coronary artery from pulmonary artery. Circulation 48(1 Suppl):III2–6PubMed

26.

Schneider T, Rickli H, Gliech V, Maeder M (2006) Bland-White-Garland syndrome and atrial septal defect – rare association and diagnostic challenge. Clin Res Cardiol 95:295–300PubMedCrossRef

27.

Schwartz ML, Jonas RA, Colan SD (1997) Anomalous origin of the left coronary artery from the pulmonary artery: recovery of left ventricular function dual coronary repair. J Am Coll Cardiol 30:547–553PubMedCrossRef

28.

Sese A, Imoto Y (1992) New technique in the transfer of an anomalously originated left coronary artery to the aorta. Ann Thorac Surg 53:527–529PubMedCrossRef

29.

Shivalkar B, Borgers M, Daenan W (1994) ALCAPA syndrome: an example of chronic myocardial hypoperfusion? J Am Coll Cardiol 23:772–778PubMedCrossRef

30.

Steen H, Merten C, Lehrke S, Lossnitzer D, Giannitsis E, Katus HA (2007) Two rare cases of left and right atrial congenital heart disease: cor triatum dexter and sinister. Clin Res Cardiol 96:122–124PubMedCrossRef

31.

Takeuchi S, Imamura H, Katsumoto K, Hayashi I, Katohgi T, Youzu R Ohkura M, Inoue T (1979) New surgical method for repair of anomalous left coronary artery from pulmonary artery. J Thorac Cardiovasc Surg 78:7–11PubMed

32.

Tiete AR, Sachweh JS, Groetzner J, Gulbins H, Muehl EG, Messmer BJ, Daebritz SH (2006) Systemic mechanical heart valve replacement in children under 16 years of age. Clin Res Cardiol 95:281–288PubMedCrossRef

33.

Turley K, Szarnicki RJ, Flachsbart KD, Richter RC, Popper RW, Tarnoff H (1995) Aortic implantation is possible in all cases of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 60:84–89PubMed

34.

Vouhe PR, Tamisier D, Sidi D, Vernant F, Mauriat P, Pouard P, Leca F (1992) Anomalous left coronary artery from the pulmonary artery: results of isolated aortic reimplantation. Ann Thorac Surg 54:621–627PubMedCrossRef

35.

Wesselhoeft H, Fawcett JS, Johnson AL (1968) Anomalous origin of the left coronary artery from the pulmonary trunk: its clinical spectrum, pathology, and pathophysiology, based on a review of 140 cases with seven further cases. Circulation 38:403–425PubMed

Titel: Anomalous origin of the left coronary artery from the pulmonary artery: mid-term results after surgical correction
verfasst von: Wlodzimierz Kuroczynski, MD
Christoph Kampmann, MD
Nalan Kayhan, MD
Markus Heinemann, MD
Diethard Pruefer, MD
Christian-Friedrich Vahl, MD
Publikationsdatum: 01.04.2008
Verlag: D. Steinkopff-Verlag
Erschienen in: Clinical Research in Cardiology / Ausgabe 4/2008
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-007-0621-x

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Anomalous origin of the left coronary artery from the pulmonary artery: mid-term results after surgical correction