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Alghamdi FA, Shah MA, Alshalash S, Alkhodair AM. Ostial stenosis of reimplanted left main coronary artery and supravalvular pulmonary stenosis: a case report of two complications of surgery for anomalous left coronary artery from the pulmonary artery. Eur Heart J Case Rep 2023; 7:ytad230. [PMID: 37187973 PMCID: PMC10180372 DOI: 10.1093/ehjcr/ytad230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/21/2022] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
Background Anomalous origin of the coronary artery from the pulmonary artery (ALCAPA) is a rare congenital disease. Surgical re-implantation of the left main coronary artery (LMCA) to the aorta is a definitive treatment with a good prognosis. Case summary A 9-year-old boy was admitted with a complaint of exertional chest pain and dyspnoea. At 13 months of age, he was diagnosed to have ALCAPA as a workup of severe left ventricular systolic dysfunction and underwent coronary re-implantation of ALCAPA. Coronary angiogram displayed the high takeoff of re-implanted LMCA with significant ostial stenosis, and echocardiogram showed significant supravalvular pulmonary stenosis (SVPS) with a peak gradient of 74 mmHg. After a multidisciplinary team discussion, he underwent percutaneous coronary intervention with stenting to ostial LMCA. On follow-up, he was asymptomatic and a cardiac computed tomography scan showed a patent stent in LMCA with an under-expanded area in the mid-segment. The proximal part of the LMCA stent was located very close to the stenotic segment of the main pulmonary artery making it a high risk for balloon angioplasty. The surgical intervention of SVPS is delayed to allow the somatic growth of the patient. Discussion Percutaneous coronary intervention in re-implanted LMCA is a feasible option. If stenosis of re-implanted LMCA is accompanied by SVPS, the latter can be best treated surgically and staged to decrease the operative risk. Our case also demonstrates the importance of long-term follow-up of post-operative complications of patients with ALCAPA.
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Affiliation(s)
- Fatima Abdullah Alghamdi
- Adult Cardiology Department, King Fahad Medical City, Dabab street, Sulaimaniya, PO Box 221124, Riyadh 11311, Saudi Arabia
| | | | - Saleh Alshalash
- Adult Cardiology Department, King Fahad Medical City, Dabab street, Sulaimaniya, PO Box 221124, Riyadh 11311, Saudi Arabia
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Lv L, Lang X, Zhang S, Wang C, Jin Y, Zhi A, Wang Q. Effectiveness and Safety of Mitral Valve Plasty in Patients with an Anomalous Origin of the Coronary Artery from the Pulmonary Artery. J Cardiovasc Dev Dis 2023; 10:jcdd10020075. [PMID: 36826571 PMCID: PMC9959487 DOI: 10.3390/jcdd10020075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
The study aimed to determine the effectiveness and safety of anomalous coronary artery from pulmonary artery (ACAPA) patients with moderate or severe mitral valve regurgitation (MVR) receiving mitral valve plasty (MVP) concurrently. Consecutive ACAPA patients undergoing surgery between 2015 and 2021 were retrospectively included. Patients were divided into three groups: moderate MVR without MVP (non-MVP (moderate) N = 14), moderate MVR with MVP (MVP (moderate) N = 13), and severe MVR with MVP (MVP (severe) N = 13). The primary safety endpoint was in-hospital surgery-related complications. The primary effectiveness outcome was left ventricular ejection function (LVEF) and left ventricular end-diastolic diameter (LVEDD) z-score at 2- and 24-month follow-ups. Multivariable linear regression models were used to obtain the β coefficient. The median age of the included patients was 7.5 years (IQR 1.4-26.5). The in-hospital surgery-related complication rates were 7.1%, 15.4%, and 7.7% in non-MVP (moderate), MVP (moderate), and MVP (severe) groups, separately. At the 2-month follow-up, the non-MVP (moderate) group had a better LVEF and LVEDD z-score compared with the MVP (moderate) group (LVEF β = 9.22, 95%CI 1.09 to 17.35; LVEDD z-score β = -2.49, 95%CI -4.53 to -0.45). At the 24-month follow-up, the LVEF of all patients and the LVEDD z-score of 90% of patients in the three groups returned to normal. For ACAPA patients with moderate MVR, MVP was not necessary, especially for pediatric patients (age < 3 years) and patients with secondary MVR. Further studies for ACAPA patients with severe MVR are still needed.
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Affiliation(s)
- Lizhi Lv
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming 650102, China
| | - Xinyue Lang
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, The National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 102308, China
| | - Simeng Zhang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Cardiac Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Cheng Wang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming 650102, China
| | - Yuanhao Jin
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Aihua Zhi
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Radiology, Yunnan Fuwai Cardiovascular Hospital, Kunming 650102, China
- Correspondence: (A.Z.); (Q.W.)
| | - Qiang Wang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming 650102, China
- Correspondence: (A.Z.); (Q.W.)
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Zhu W, Sun J, Bishop SP, Sadek H, Zhang J. Turning back the clock: A concise viewpoint of cardiomyocyte cell cycle activation for myocardial regeneration and repair. J Mol Cell Cardiol 2022; 170:15-21. [PMID: 35660800 PMCID: PMC9391298 DOI: 10.1016/j.yjmcc.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/18/2022] [Accepted: 05/14/2022] [Indexed: 11/25/2022]
Abstract
Patients with acute myocardial infarction (MI) could progress to end-stage congestive heart failure, which is one of the most significant problems in public health. From the molecular and cellular perspective, heart failure often results from the loss of cardiomyocytes-the fundamental contractile unit of the heart-and the damage caused by myocardial injury in adult mammals cannot be repaired, in part because mammalian cardiomyocytes undergo cell-cycle arrest during the early perinatal period. However, recent studies in the hearts of neonatal small and large mammals suggest that the onset of cardiomyocyte cell-cycle arrest can be reversed, which may lead to the development of entirely new strategies for the treatment of heart failure. In this Viewpoint, we summarize these and other provocative findings about the cellular and molecular mechanisms that regulate cardiomyocyte proliferation and how they may be targeted to turn back the clock of cardiomyocyte cell-cycle arrest and improve recovery from cardiac injury and disease.
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Affiliation(s)
- Wuqiang Zhu
- Department of Cardiovascular Diseases, Physiology and Biomedical Engineering, Center for Regenerative Medicine, Mayo Clinic, Scottsdale, AZ 85259, United States of America
| | - Jiacheng Sun
- Department of Biomedical Engineering, School of Medicine and School of Engineering, the University of Alabama at Birmingham, Birmingham, AL 35294, United States of America
| | - Sanford P Bishop
- Department of Biomedical Engineering, School of Medicine and School of Engineering, the University of Alabama at Birmingham, Birmingham, AL 35294, United States of America
| | - Hesham Sadek
- Division of Cardiovascular Diseases, UT Southwestern Medical Center, United States of America
| | - Jianyi Zhang
- Department of Biomedical Engineering, School of Medicine and School of Engineering, the University of Alabama at Birmingham, Birmingham, AL 35294, United States of America; Department of Medicine, Division of Cardiovascular Diseases, School of Medicine, the University of Alabama at Birmingham, Birmingham, AL 35294, United States of America.
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Luo XY, Zheng B, Wu L, Huo Y. Intravascular ultrasound-guided stent implantation in reimplanted left main coronary artery of a 15-year-old child: a case report. Eur Heart J Case Rep 2022; 6:ytac070. [PMID: 35198854 PMCID: PMC8855697 DOI: 10.1093/ehjcr/ytac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/23/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Only a few cases have been reported about clinical value of percutaneous coronary intervention (PCI) and intravascular ultrasound (IVUS) in patients with stenosis of a re-implanted left main coronary artery (LMCA). CASE SUMMARY We herein report a rare case of restenosis after direct reimplantation of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in a 15-year-old girl. At the first evaluation, she had mildly reduced systolic dysfunction with left ventricular ejection fraction of 47%. Three months after surgical repair, the patient developed recurrent precordial pain. Consequent imaging tests and IVUS revealed a restenosis of the LMCA characterized as an attenuated plaque with a large plaque burden. A drug-eluting stent was implanted with IVUS guidance. Follow-up revealed a patent LMCA and preserved systolic function. DISCUSSION The current case demonstrated that IVUS-guided PCI can be feasible in the treatment of coronary artery stenosis after repair of an ALCAPA. Further study is needed to explore the pathophysiological mechanism of this condition and the clinical value of PCI and IVUS in patients with stenosis of the LMCA.
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Affiliation(s)
- Xing Yu Luo
- Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Bo Zheng
- Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing 100034, China.,Institute of Cardiovascular Disease, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Lin Wu
- Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing 100034, China.,Institute of Cardiovascular Disease, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Yong Huo
- Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing 100034, China.,Institute of Cardiovascular Disease, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing 100034, China
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Early Presentation of Patients with Abnormal Origin of Left Coronary Artery from the Pulmonary Artery is a Predictor of Poor Mid-term Outcomes. Pediatr Cardiol 2022; 43:719-725. [PMID: 34797395 PMCID: PMC8602883 DOI: 10.1007/s00246-021-02777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
Abnormal origin of left coronary artery from the pulmonary artery (ALCAPA) is one of the most common causes of myocardial ischemia and infarction in childhood. This study aimed to determine the correlation between age at clinical presentation, level of ventricular dysfunction, and post-repair outcomes. This is retrospective study from 1993 to 2018 including thirty-one patients. The study cohort was divided into two groups according to age (< 6 months, > 6 months). The significance level was set at p 0.05.The median follow-up time was 72 [24-168] months. Median age was 4.7 [2.3-16] months. Median weight was 6.2 [4.3-9] kg. There was severe left ventricular (LV) dysfunction (ejection fraction < 35%) in 64.5% of patients. Mitral regurgitation (MR) was moderate to severe in 13 patients (41.9%). Two patients (6.4%) required extracorporeal membrane oxygenation (ECMO) support before surgery and 6 (19.4%) after correction. Age < 6 months was significantly associated with severe clinical presentation, severe LV dysfunction, delayed sternal closure, prolonged respiratory mechanical support, and prolonged length of ICU stay (p = 0.024, p = 0.042, p = 0.002, p = 0.042, p = 0.022, respectively). After surgery, ejection fraction improved to a median of 57% [50.7-60.5]. MR regressed in 12 patients (92.3%). Mortality rate after surgery was 9.7%. All patients were free from reoperation at the last follow-up. Young age at diagnosis was significantly associated with a more severe clinical presentation and poorer outcomes. After re-establishment of a two-coronary circulation, both ventricular function and MR tend to normalize over time regardless of age at repair.
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Cashen K, Kwiatkowski DM, Riley CM, Buckley J, Sassalos P, Gowda KN, Iliopoulos I, Bakar A, Chiwane S, Badheka A, Moser EAS, Mastropietro CW. Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery: A Retrospective Multicenter Study. Pediatr Crit Care Med 2021; 22:e626-e635. [PMID: 34432672 DOI: 10.1097/pcc.0000000000002820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to describe characteristics and operative outcomes from a multicenter cohort of infants who underwent repair of anomalous left coronary artery from the pulmonary artery. We also aimed to identify factors associated with major adverse cardiovascular events following anomalous left coronary artery from the pulmonary artery repair. DESIGN Retrospective chart review. SETTING Twenty-one tertiary-care referral centers. PATIENTS Infants less than 365 days old who underwent anomalous left coronary artery from the pulmonary artery repair. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Major adverse cardiovascular events were defined as the occurrence of postoperative extracorporeal membrane oxygenation, cardiopulmonary resuscitation, left ventricular assist device, heart transplantation, or operative mortality. Factors independently associated with major adverse cardiovascular events were identified using multivariable logistic regression analysis. We reviewed 177 infants (< 365 d old) who underwent anomalous left coronary artery from the pulmonary artery repair between January 2009 and March 2018. Major adverse cardiovascular events occurred in 36 patients (20%). Twenty-nine patients (16%) received extracorporeal membrane oxygenation, 14 (8%) received cardiopulmonary resuscitation, four (2%) underwent left ventricular assist device placement, two (1%) underwent heart transplantation, and six (3.4%) suffered operative mortality. In multivariable analysis, preoperative inotropic support (odds ratio, 3.5; 95% CI, 1.4-8.5), cardiopulmonary bypass duration greater than 150 minutes (odds ratio, 6.9 min; 95% CI, 2.9-16.7 min), and preoperative creatinine greater than 0.3 mg/dL (odds ratio, 2.4 mg/dL; 95% CI, 1.1-5.6 mg/dL) were independently associated with major adverse cardiovascular events. In patients with preoperative left ventricular end-diastolic diameter measurements available (n = 116), left ventricular end-diastolic diameter z score greater than 6 was also independently associated with major adverse cardiovascular events (odds ratio, 7.6; 95% CI, 2.0-28.6). CONCLUSIONS In this contemporary multicenter analysis, one in five children who underwent surgical repair of anomalous left coronary artery from the pulmonary artery experienced major adverse cardiovascular events. Preoperative characteristics such as inotropic support, creatinine, and left ventricular end-diastolic diameter z score should be considered when planning for potential postoperative complications.
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Affiliation(s)
- Katherine Cashen
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - David M Kwiatkowski
- Department of Pediatrics, Pediatric Heart Center Lucille Packard Children's Hospital, Palo Alto, CA
| | - Christine M Riley
- Department of Pediatrics, Children's National Health System, Washington, DC
| | - Jason Buckley
- Department of Pediatrics, Medical University of South Carolina Children's Hospital, Charleston, SC
| | - Peter Sassalos
- Department of Cardiac Surgery, University of Michigan, CS Mott Children's Hospital, Ann Arbor, MI
| | | | - Ilias Iliopoulos
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Adnan Bakar
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center of New York, New Hyde Park, NY
| | - Saurabh Chiwane
- Department of Pediatrics, Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Aditya Badheka
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Elizabeth A S Moser
- Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Christopher W Mastropietro
- Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
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Thomas AS, Chan A, Alsoufi B, Vinocur JM, Kochilas L. Long-term Outcomes of Children Operated for Anomalous Left Coronary Artery from the Pulmonary Artery. Ann Thorac Surg 2021; 113:1223-1230. [PMID: 34419434 DOI: 10.1016/j.athoracsur.2021.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND We examined the outcomes of children (<18 years) operated for anomalous left coronary artery from the pulmonary artery (ALCAPA). METHODS We linked patients undergoing ALCAPA repair between 1982 and 2003 in the Pediatric Cardiac Care Consortium with the National Death Index and the Organ Procurement and Transplantation Network, to examine their outcomes through 2019. RESULTS We identified 228 children (median age 6.0 months) operated for ALCAPA. At time of repair, 38.6% had severe mitral regurgitation (MR) and 71.4% severe left ventricular (LV) dysfunction. Repair included primarily coronary reimplantation (n=173) and Takeuchi procedure (n=34); concurrently, 18 underwent mitral valve (MV) surgery. In-hospital death occurred in 31 (13.6%) and was not associated with MR severity (p=0.846); however, among patients with moderate or severe MR, risk of death was 28% lower when undergoing MV surgery (p=0.033). After adjustment for other risk factors, only infant surgery reached statistical significance for in-hospital death (aOR=12.99; 95% CI: 1.61, 104.59, p=0.016). Among those discharged alive with long-term data available (n=155), the 30-year transplant-free survival reached 95.5% (95% CI: 92.3-98.8) and was not associated with degree of pre-operative MR or LV dysfunction. Coronary reimplantation was associated with better long-term survival compared to other surgical techniques (aOR=0.11; 95% CI 0.02-0.74, p=0.023). CONCLUSIONS Favorable long-term outcomes can be expected after coronary artery reimplantation for ALCAPA even in cases with severe LV dysfunction at presentation. MV surgery predicted decreased risk for in-hospital mortality in patients with moderate/severe MR, but MR severity predicted neither in-hospital nor longer-term outcomes.
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Affiliation(s)
- Amanda S Thomas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Alice Chan
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Bahaaldin Alsoufi
- Department of Cardiothoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY
| | - Jeffrey M Vinocur
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Lazaros Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, GA.
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Hu R, Zhang W, Yu X, Zhu H, Zhang H, Liu J. Midterm Surgical Outcomes for ALCAPA Repair in Infants and Children. Thorac Cardiovasc Surg 2021; 70:2-9. [PMID: 33851407 DOI: 10.1055/s-0041-1725978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical correction of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) has been associated with excellent survival during recent years. The purpose of this study was to evaluate the effectiveness of reimplantation of the coronary artery and to investigate the recovery of postoperative cardiac and mitral valve (MV) function. METHODS From 2005 to 2015, 80 patients who had ALCAPA received surgical correction. Among them, 49 were infants. The median patient age was 7.8 months. Operative strategies included reimplantation of the coronary artery in 71 patients, the Takeuchi procedure in another 7 patients, and coronary artery ligation in the remaining 2 patients. RESULTS There were 11 hospital deaths and 2 late deaths. Six patients required intraoperative or postoperative mechanical circulatory support. A significant improvement in the ejection fraction (EF) and shortening fraction (SF) was present in all surviving patients at discharge, at a 3-month follow-up and at a 1-year follow-up. MV function improved gradually after surgical repair with no late secondary intervention. CONCLUSIONS The repair of ALCAPA can be accomplished by establishment of a dual-coronary system, which offers an acceptable mortality rate and will rarely require a second surgery. Left ventricular (LV) recovery is a progressive process, especially for infants with impaired LV function. Concomitant MV annuloplasty is safe and reliable and can be performed as necessary in patients with moderate or severe mitral valve regurgitation.
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Affiliation(s)
- Renjie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Wen Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Xiafeng Yu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Hongbin Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Jinfen Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Triglia LT, Guariento A, Zanotto L, Zanotto L, Cattapan C, Hu R, Zhang H, Herbst C, Hörer J, Sarris G, Ebels T, Maruszewski B, Tobota Z, Blitzer D, Lorenzoni G, Bottigliengo D, Gregori D, Padalino M, Di Salvo G, Vida VL. Anomalous left coronary artery from pulmonary artery repair: Outcomes from the European Congenital Heart Surgeons Association Database. J Card Surg 2021; 36:1910-1916. [PMID: 33651393 DOI: 10.1111/jocs.15448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/07/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We sought to determine the surgical outcomes of patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) enrolled in the European Congenital Heart Surgeons Association (ECHSA) database. MATERIALS AND METHODS From 1999 to 2019, 907 patients with ALCAPA underwent surgical repair and were included in the current study. The primary outcome was in-hospital mortality. Secondary outcomes included frequency and results of concomitant mitral valve surgery and postoperative mechanical circulatory support (MCS). RESULTS The overall in-hospital mortality was 6% (54/907) and was significantly higher in neonates (p = .01), patients with lower body surface area (BSA) (p = .01), and those requiring postoperative MCS (p = .001). Associated mitral valve surgery was performed in 144 patients (15.9%) and was associated with longer cardiopulmonary bypass (CPB) and aortic cross-clamp times (AOX) (p ≤ .0001) but was not significantly related to an increase in in-hospital mortality. Postoperative MCS was required in 66 patients (7.3%). These patients were younger (p ≤ .001), had a lower BSA (p ≤ .001), and required a longer CPB (p ≤ .001) and AOX time (p ≤ .001). CONCLUSIONS ALCAPA repair can be achieved successfully, and with low surgical risk. Concomitant mitral valve procedures can be performed without increasing operative mortality. The use of MCS remains a valuable option, especially in younger patients.
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Affiliation(s)
- Laura Torlai Triglia
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Claudia Cattapan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Renjie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Claudia Herbst
- Department of Surgery, Division of Cardiac Surgery and Pediatric Heart Center, Medical University Vienna, Vienna, Austria
| | - Jurgen Hörer
- Division for Congenital and Pediatric Heart Surgery, University Hospital of Munich (LUM), Munich, Germany
| | - George Sarris
- Department of Pediatric and Congenital Cardiac Surgery, Athens Heart Surgery Institute, IASO Children's Hospital, Athens, Greece
| | - Tjark Ebels
- Departments of Congenital Cardiothoracic Surgery Thoraxcentrum, University Medical Center Groningen, Groningen, Netherlands
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
| | - Zdzislaw Tobota
- Department for Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
| | - David Blitzer
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | | | | | - Dario Gregori
- Biostatistic Unit, University of Padua, Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giovanni Di Salvo
- Department of Children and Woman's Health, Pediatric Cardiology Unit, University of Padua, Padua, Italy
| | - Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Ismail M, Jijeh A, Alhuwaymil RM, Alahmari R, Alshahrani R, Almutairi R, Habshan F, Shaath GA. Long-Term Outcome of the Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery (ALCAPA) in Children After Cardiac Surgery: A Single-Center Experience. Cureus 2020; 12:e11829. [PMID: 33409071 PMCID: PMC7781494 DOI: 10.7759/cureus.11829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary artery anomaly. It induces left ventricular (LV) dysfunction and mitral valve regurgitation (MR). If untreated, survival beyond infancy is rare. The aim of our study was to analyze the outcome in children with ALCAPA after cardiac surgery. Methods We retrospectively reviewed all patients who were diagnosed at our institution with ALCAPA and underwent surgical repair from 1999 to the end of 2018 (for 20 years). We followed LV dimensions, function, the progress of MV regurgitation, and the somatic growth of children after surgical repair. Results Twenty-nine patients underwent ALCAPA repair while 15 (52%) patients were male. The median age at surgical repair was 5.3 (IQR: 3.8-7.4) months and the mean weight was 5.5±2 kg. Surgical repair was performed in form of coronary reimplantation in 26 (90%) patients and Takeuchi repair in three (10%) patients. Intensive care unit (ICU) stay was eight (IQR: 6-17) days and hospital stay was 15 (IQR: 12-21) days. The follow-up duration was 5±3.6 years. Echocardiographic parameters started to improve by six weeks after the repair, and they normalized by one year. At the time of surgery ejection fraction (EF) was 34±17%, fractional shortening (FS) was 15±10%, and LV inner diameter in diastole (LVIDD) z score was 5.7±2.8. These parameters improved by one year after surgery to 66±7%, 34±6%, and 0±1.3, respectively. However, somatic growth started to improve six months after surgical repair. MR was moderate to severe in seven (24%) patients at the time of surgery and regressed to no more moderate nor severe MR at the last follow-up. None of the 29 patients died. Conclusions LV systolic function and dimensions start to improve by six weeks after surgery and reach normal values by one year. MR regresses without intervention in correspondence with the regression of LV dimensional parameters. The somatic growth of children improves six months after repair.
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Affiliation(s)
- Muna Ismail
- Cardiac Sciences Department, Pediatric Cardiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, SAU
| | - Abdulraouf Jijeh
- Cardiac Sciences Department, Pediatric Cardiac Intensive Care Unit, Ministry of National Guard - Health Affairs, Riyadh, SAU
| | - Rathath M Alhuwaymil
- Echocardiographic Technology, College of Applied Medical Sciences King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Raneem Alahmari
- Echocardiographic Technology, College of Applied Medical Sciences King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Rawan Alshahrani
- Echocardiographic Technology, College of Applied Medical Sciences King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Reem Almutairi
- Echocardiographic Technology, College of Applied Medical Sciences King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Fahad Habshan
- King Abdulaziz Cardiac Center, Pediatric Cardiology, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Ghassan A Shaath
- Cardiac Sciences Department, Pediatric Cardiac Intensive Care Unit, King Abdulaziz Cardiac Center. Ministry of the National Guard - Health Affairs, Riyadh, SAU
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11
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Dodge-Khatami A. Anomalous Left Coronary Artery From the Pulmonary Artery and Missed Opportunities to Provide Clarity Using Multicenter Databases: More Is Not Always Helpful. Ann Thorac Surg 2020; 112:1316. [PMID: 33058823 DOI: 10.1016/j.athoracsur.2020.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Ali Dodge-Khatami
- Division of Pediatric & Congenital Heart Surgery, Cohen Children's Medical Center/Northwell Health, 1111 Marcus Ave, Ste M15, New Hyde Park, NY 11042.
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12
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Intermediate Outcomes After Repair of Anomalous Left Coronary Artery From the Pulmonary Artery. Ann Thorac Surg 2020; 112:1307-1315. [PMID: 32961142 DOI: 10.1016/j.athoracsur.2020.06.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multicenter studies on infants with anomalous left coronary artery from the pulmonary artery (ALCAPA) are lacking. We report the intermediate-term outcomes after ALCAPA repair in a multicenter cohort and identify risk factors for reintervention or death after discharge. METHODS We retrospectively reviewed infants under 1 year of age who underwent ALCAPA repair from January 2009 to March 2018 at 21 US centers. The primary composite outcome was freedom from reintervention or death after discharge. We used the Kaplan-Meier survival analysis to examine freedom from reintervention or death and the Cox proportional hazard analysis to identify risk factors for this composite outcome. RESULTS One hundred seventy-seven infants underwent ALCAPA repair; 170 (97%) survived to hospital discharge without transplantation. Twenty-three patients were lost to follow-up. The median duration of follow-up in the remaining 147 patients was 3.8 years (25%, 75%: 1.9 years, 6.0 years). Echocardiographic data were available at ∼3 years after discharge in 98 patients. Left ventricular function was normal in 96 patients (98%), whereas 26 patients (27%) had greater than mild mitral valve regurgitation. Sixteen patients (11%) underwent 20 reinterventions with 1 late death. Patients undergoing the Takeuchi procedure or atypical repairs (hazard ratio, 8.0; 95% confidence interval, 2.1-30.0) or with moderate or greater mitral regurgitation on discharge echocardiogram (hazard ratio, 3.4; 95% confidence interval, 1.2-9.1) were at increased risk for reintervention. CONCLUSIONS Intermediate-term outcomes after ALCAPA repair in infants are favorable. Persistent left ventricular dysfunction and reinterventions were uncommon, and mortality was rare. Patients who required atypical surgical repair or had moderate or greater mitral regurgitation at discharge warrant closer follow-up.
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13
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Jinmei Z, Yunfei L, Yue W, Yongjun Q. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) diagnosed in children and adolescents. J Cardiothorac Surg 2020; 15:90. [PMID: 32398101 PMCID: PMC7218579 DOI: 10.1186/s13019-020-01116-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare but potentially fatal congenital coronary anomaly associated with early infant mortality and sudden adult death. By the development or lack of coronary collateral, it can be classified as infantile or adult type. However, even with the compensatory mechanism in adult patients, there is an estimated 80 to 90% incidence of sudden death at the mean age of 35 years. Methods We enrolled 9 patients with ALCAPA within the age group 5 to 16 years. Results Only one patient developed symptoms (apsychia), whereas other patients were asymptomatic, and there was no evident left ventricular dysfunction found in any of the cases. Conclusion With the development of imaging techniques, asymptomatic adult-type ALCAPA patients could be identified and diagnosed in childhood or adolescence. As a potential cause of sudden death, ALCAPA should be surgically repaired soon after the diagnosis.
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Affiliation(s)
- Zhang Jinmei
- Department of Intensive Care Unit, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Ling Yunfei
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Wang Yue
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qian Yongjun
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
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14
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Moshref L, Moshref R, Faden M, Al-Radi O. The outcome of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in infants. THE CARDIOTHORACIC SURGEON 2019. [DOI: 10.1186/s43057-019-0003-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Neumann A, Sarikouch S, Bobylev D, Meschenmoser L, Breymann T, Westhoff-Bleck M, Scheid M, Tzanavaros I, Bertram H, Beerbaum P, Haverich A, Boethig D, Horke A. Long-term results after repair of anomalous origin of left coronary artery from the pulmonary artery: Takeuchi repair versus coronary transfer. Eur J Cardiothorac Surg 2019; 51:308-315. [PMID: 28186291 DOI: 10.1093/ejcts/ezw268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/28/2016] [Accepted: 07/04/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Luitgard Meschenmoser
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thomas Breymann
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Michael Scheid
- Center of Congenital Cardiac Disease, Sana Cardiac Surgical Clinic Stuttgart, Stuttgart, Germany
| | - Ioannis Tzanavaros
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Harald Bertram
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Alexander Horke
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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16
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Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA): a Systematic Review and Historical Perspective. CURRENT PEDIATRICS REPORTS 2019. [DOI: 10.1007/s40124-019-00191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Percutaneous Coronary Intervention in an 8-Month-Old Infant for Ostial Stenosis of a Reimplanted Left Main Coronary Artery. Case Rep Cardiol 2018; 2018:2512406. [PMID: 30533226 PMCID: PMC6250020 DOI: 10.1155/2018/2512406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/21/2018] [Indexed: 11/29/2022] Open
Abstract
Percutaneous coronary intervention (PCI) is a routine procedure undertaken in adult patients. In children, the procedure remains rare and challenging due to a multitude of factors including but not limited to complex congenital heart disease anatomy, catheter and stent to patient size mismatch, and lack of data for post-PCI antiplatelet therapy. We present a case of PCI in an 8-month-old infant with anomalous left coronary artery from pulmonary artery (ALCAPA) who developed severe ostial kinking of the left main coronary artery (LMCA) after surgical reimplantation of the anomalous coronary. A 3.5 × 8 mm Vision bare metal stent was successfully placed into the LMCA and postdilated with excellent results. Follow-up echocardiography at 6 months post-PCI demonstrated a patent stent with normal Doppler flow signals. Despite initial success, the infant developed severe heart failure and was listed for orthotopic heart transplantation at age 20 months, one year after PCI. Given the paucity of published data regarding PCI and outcomes in infants with ALCAPA after surgical reimplantation, we describe our case and present a review of the available literature.
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18
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Zhu W, Zhang E, Zhao M, Chong Z, Fan C, Tang Y, Hunter JD, Borovjagin AV, Walcott GP, Chen JY, Qin G, Zhang J. Regenerative Potential of Neonatal Porcine Hearts. Circulation 2018; 138:2809-2816. [PMID: 30030418 DOI: 10.1161/circulationaha.118.034886] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rodent hearts can regenerate myocardium lost to apical resection or myocardial infarction for up to 7 days after birth, but whether a similar window for myocardial regeneration also exists in large mammals is unknown. METHODS Acute myocardial infarction (AMI) was surgically induced in neonatal pigs on postnatal days 1, 2, 3, 7, and 14 (ie, the P1, P2, P3, P7, and P14 groups, respectively). Cardiac systolic function was evaluated before AMI and at 30 days post-AMI via transthoracic echocardiography. Cardiomyocyte cell cycle activity was assessed via immunostaining for proliferation and mitosis markers, infarct size was evaluated histologically, and telomerase activity was measured by quantitative polymerase chain reaction. RESULTS Systolic function at day 30 post-AMI was largely restored in P1 animals and partially restored in P2 animals, but significantly impaired when AMI was induced on postnatal day 3 or later. Hearts of P1 animals showed little evidence of scar formation or wall thinning on day 30 after AMI, with increased measures of cell-cycle activity seen 6 days after AMI (ie, postnatal day 7) compared with postnatal day 7 in noninfarcted hearts. CONCLUSIONS The neonatal porcine heart is capable of regeneration after AMI during the first 2 days of life. This phenomenon is associated with induction of cardiomyocyte proliferation and is lost when cardiomyocytes exit the cell cycle shortly after birth.
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Affiliation(s)
- Wuqiang Zhu
- Department of Biomedical Engineering, School of Medicine, and School of Engineering (W.Z., E.Z., M.Z., C.F., Y.T., J.D.H., A.V.B., G.P.W., G.Q., J.Z.), University of Alabama at Birmingham
| | - Eric Zhang
- Department of Biomedical Engineering, School of Medicine, and School of Engineering (W.Z., E.Z., M.Z., C.F., Y.T., J.D.H., A.V.B., G.P.W., G.Q., J.Z.), University of Alabama at Birmingham
| | - Meng Zhao
- Department of Biomedical Engineering, School of Medicine, and School of Engineering (W.Z., E.Z., M.Z., C.F., Y.T., J.D.H., A.V.B., G.P.W., G.Q., J.Z.), University of Alabama at Birmingham
| | - Zechen Chong
- Department of Genetics (Z.C.), University of Alabama at Birmingham
| | - Chengming Fan
- Department of Biomedical Engineering, School of Medicine, and School of Engineering (W.Z., E.Z., M.Z., C.F., Y.T., J.D.H., A.V.B., G.P.W., G.Q., J.Z.), University of Alabama at Birmingham
| | - Yawen Tang
- Department of Biomedical Engineering, School of Medicine, and School of Engineering (W.Z., E.Z., M.Z., C.F., Y.T., J.D.H., A.V.B., G.P.W., G.Q., J.Z.), University of Alabama at Birmingham
| | - Jervaughn D Hunter
- Department of Biomedical Engineering, School of Medicine, and School of Engineering (W.Z., E.Z., M.Z., C.F., Y.T., J.D.H., A.V.B., G.P.W., G.Q., J.Z.), University of Alabama at Birmingham
| | - Anton V Borovjagin
- Department of Biomedical Engineering, School of Medicine, and School of Engineering (W.Z., E.Z., M.Z., C.F., Y.T., J.D.H., A.V.B., G.P.W., G.Q., J.Z.), University of Alabama at Birmingham
| | - Gregory P Walcott
- Department of Biomedical Engineering, School of Medicine, and School of Engineering (W.Z., E.Z., M.Z., C.F., Y.T., J.D.H., A.V.B., G.P.W., G.Q., J.Z.), University of Alabama at Birmingham
| | - Jake Y Chen
- Informatics Institute (J.Y.C.), University of Alabama at Birmingham
| | - Gangjian Qin
- Department of Biomedical Engineering, School of Medicine, and School of Engineering (W.Z., E.Z., M.Z., C.F., Y.T., J.D.H., A.V.B., G.P.W., G.Q., J.Z.), University of Alabama at Birmingham
| | - Jianyi Zhang
- Department of Biomedical Engineering, School of Medicine, and School of Engineering (W.Z., E.Z., M.Z., C.F., Y.T., J.D.H., A.V.B., G.P.W., G.Q., J.Z.), University of Alabama at Birmingham
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19
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Abstract
BACKGROUND The adult mammalian heart is incapable of meaningful functional recovery after injury, and thus promoting heart regeneration is 1 of the most important therapeutic targets in cardiovascular medicine. In contrast to the adult mammalian heart, the neonatal mammalian heart is capable of regeneration after various types of injury. Since the first report in 2011, a number of groups have reported their findings on neonatal heart regeneration. The current review provides a comprehensive analysis of heart regeneration studies in neonatal mammals conducted to date, outlines lessons learned, and poses unanswered questions. METHODS We performed a PubMed search using the keywords "neonatal" and "heart" and "regeneration." In addition, we assessed all publications that cited the first neonatal heart regeneration reports: Porrello et al, Science, Feb 2011 for apical resection injury; Porrello et al, PNAS, Dec 2012 for coronary ligation injury; and Mahmoud et al, Nature Methods, Jan 2014 for surgical methodology. Publications were examined for surgical models used, timing of surgery, and postinjury assessment including anatomic, histological, and functional assessment, as well as conclusions drawn. RESULTS We found 30 publications that performed neonatal apical resection, 19 publications that performed neonatal myocardial infarction by coronary artery ligation, and 6 publications that performed cryoinjury using liquid nitrogen-cooled metal probes. Both apical resection and ischemic infarction injury in neonatal mice result in a robust regenerative response, mediated by cardiomyocyte proliferation. On the other hand, several reports have demonstrated that cryoinjury is associated with incomplete heart regeneration in neonatal mice. Not surprisingly, several studies suggest that injury size, as well as surgical and histological techniques, can strongly influence the observed regenerative response and final conclusions. Studies have utilized these neonatal cardiac injury models to identify factors that either inhibit or stimulate heart regeneration. CONCLUSIONS Overall, there is consensus that both apical resection and coronary ligation injuries during the first 2 days of life result in heart regeneration in neonatal mammals, whereas cryoinjury was not associated with a similar regenerative response. This regenerative response is mediated by proliferation of preexisting cardiomyocytes, and is modifiable by injury size and surgical technique, as well as metabolic, immunologic, genetic, and environmental factors.
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Affiliation(s)
- Nicholas T Lam
- Department of Internal Medicine, Division of Cardiology (N.T.L and H.A.S.)
| | - Hesham A Sadek
- Department of Internal Medicine, Division of Cardiology (N.T.L and H.A.S.).,Hamon Center for Regenerative Science and Medicine (H.A.S.), University of Texas Southwestern Medical Center, Dallas
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20
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Gao Y, Zhang J, Huang GY, Liang XC, Jia B, Ma XJ. Surgical Outcomes of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Children: An Echocardiography Follow-up. Chin Med J (Engl) 2018; 130:2333-2338. [PMID: 28937040 PMCID: PMC5634085 DOI: 10.4103/0366-6999.215334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare but potentially life-threatening congenital heart defect. A retrospective analysis was carried out to elucidate the surgical outcomes of ALCAPA in infants and children using follow-up echocardiography. METHODS From September 2008 to March 2017, 26 children diagnosed with ALCAPA underwent left coronary re-implantation. All surviving patients received echocardiography during follow-up. RESULTS The mortality rate after the operation was 11.5%. Before repair, twenty patients (76.9%) presented with left ventricular (LV) dysfunction. The mean Z-score of the preoperative LV end-diastolic diameter was 4.42 ± 2.09. Mitral regurgitation (MR) was present in all patients. Two patients (7.7%), both with mitral valve prolapse, underwent mitral valve repair at the time of ALCAPA repair. Two children required postoperative extracorporeal membrane oxygenation. LV function normalized at a median time of 5.3 months (range: 0.5-36.0 months). The Z-score of the LV end-diastolic diameter decreased simultaneously. The degree of MR gradually decreased in all surviving patients. All patients had patency of the proximal left coronary artery confirmed by echocardiography at the most recent follow-up. Six patients (26.1%) showed supravalvar pulmonary stenosis and seven patients (30.4%) showed right pulmonary stenosis during follow-up. CONCLUSIONS Coronary re-implantation was effective for rebuilding a dual coronary system in patients with ALCAPA and resulted in progressive improved LV function and reduced functional MR. Echocardiography was valuable for evaluating the outcomes. LV function, the degree of MR, and possible complications could be detected with follow-up echocardiography.
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Affiliation(s)
- Yan Gao
- Heart Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Jing Zhang
- Heart Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Guo-Ying Huang
- Heart Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xue-Cun Liang
- Heart Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Bing Jia
- Heart Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xiao-Jing Ma
- Heart Center, Children's Hospital of Fudan University, Shanghai 201102, China
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21
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Guzeltas A, Ozturk E, Tanidir IC, Kasar T, Haydin S. Evaluation of Anomalous Coronary Arteries from the Pulmonary Artery. Braz J Cardiovasc Surg 2017; 32:29-37. [PMID: 28423127 PMCID: PMC5382903 DOI: 10.21470/1678-9741-2016-0082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/05/2017] [Indexed: 11/29/2022] Open
Abstract
Objective This study evaluated clinical and diagnostic findings, treatment methods, and
follow-up of cases of anomalous coronary arteries from the pulmonary
artery. Methods The study included all cases diagnosed with anomalous coronary arteries from
the pulmonary artery between January 2012 and January 2016. Data from
patients’ demographic characteristics, electrocardiography,
echocardiography, angiographic findings, operation, intensive care unit
stay, and follow-up were evaluated. Results The study included 12 patients (8 male, 4 female), 10 with anomalous left
coronary artery from the pulmonary artery (ALCAPA) and 2 with anomalous
right coronary artery from the pulmonary artery (ARCAPA). Median age at
diagnosis was 4 months (range, 1 month - 10 years old) and median weight was
5.5 kg (range, 3-30 kg). The most common complaints were murmur (n=7) and
respiratory distress (n=5). In 4 cases, the initial diagnosis was dilated
cardiomyopathy. Electrocardiographs were pathologic in all cases.
Echocardiographic examination revealed medium to severe mitral valve
regurgitation in 4 cases and reduced (< 40%) ejection fraction in 6
patients. Of the 12 patients, 8 underwent direct implantation of the left
coronary artery into the aorta, 2 underwent implantation of the right
coronary artery into the aorta, and the remaining 2 underwent a Takeuchi
procedure. There were no early mortalities. Median hospital stay was 20 days
(range, 5-35 days). Median follow-up duration was 18 months (range, 5-36
months), and no cases required further surgery during follow-up. Conclusions Anomalous coronary arteries from the pulmonary artery can be successfully
repaired providing there is early diagnosis and effective, appropriate
intensive care unit follow-up. Therefore, coronary artery origins should be
evaluated carefully, especially in cases with dilated cardiomyopathies.
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Affiliation(s)
- Alper Guzeltas
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Ibrahim Cansaran Tanidir
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Taner Kasar
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
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22
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Lange R, Cleuziou J, Krane M, Ewert P, Pabst von Ohain J, Beran E, Vitanova K. Long-term outcome after anomalous left coronary artery from the pulmonary artery repair: a 40-year single-centre experience. Eur J Cardiothorac Surg 2017; 53:732-739. [DOI: 10.1093/ejcts/ezx407] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/23/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
- German Heart Center Munich–DZHK Partner Site Munich Heart Alliance, Munich, Germany
| | - Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Markus Krane
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
- German Heart Center Munich–DZHK Partner Site Munich Heart Alliance, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Jelena Pabst von Ohain
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Elisabeth Beran
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
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23
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Mavroudis C. Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery Presenting in Adulthood: A French Nationwide Retrospective Study, an Editorial Commentary. Semin Thorac Cardiovasc Surg 2017; 29:S1043-0679(17)30293-9. [PMID: 29175205 DOI: 10.1053/j.semtcvs.2017.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 11/11/2022]
Abstract
Adults with anomalous left coronary artery from the pulmonary artery typically have multiple venous and arterial collateral arteries surrounding the artery, making precise ligation imperative. Most physicians delay mitral valve repair until left ventricular function improves allowing for reperfusion through a 2-coronary system reimplanting the anomalous left coronary artery from the pulmonary artery into the aorta.
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Affiliation(s)
- Constantine Mavroudis
- Florida Hospital for Children, Johns Hopkins University School of Medicine, Orlando, Florida.
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Dhar A, Aronowitz D, Misra N, Meyer DB. Surgical Angioplasty of Stenotic Left Main Coronary Artery 15 Years After ALCAPA Repair. Ann Thorac Surg 2017; 104:e269-e270. [PMID: 28838525 DOI: 10.1016/j.athoracsur.2017.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 02/28/2017] [Accepted: 03/14/2017] [Indexed: 11/24/2022]
Abstract
Studies regarding long-term results after repair of anomalous left main coronary artery from the pulmonary artery (ALCAPA) have mainly focused on survival rates, left ventricular function, and mitral valve function. The development of left main coronary stenosis following repair has been infrequently reported and its incidence unknown. Optimal therapy is also not known. Here we report the use of surgical angioplasty to achieve revascularization of a stenotic left main coronary artery in a patient with ALCAPA who had undergone coronary transfer 15 years earlier.
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Affiliation(s)
- Arushi Dhar
- Department of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, New York.
| | | | - Nilanjana Misra
- Department of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - David Benjamin Meyer
- Department of Pediatric Cardiothoracic Surgery, Cohen Children's Medical Center of New York, New Hyde Park, New York
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Zhang H, Cheng P, Jin G, Han D, Luo Y, Li J. Surgical strategies for anomalous origin of the left coronary artery from the right pulmonary artery with an intramural aortic course: A report of 10 cases. J Thorac Cardiovasc Surg 2017; 153:648-653. [DOI: 10.1016/j.jtcvs.2016.10.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 09/22/2016] [Accepted: 10/03/2016] [Indexed: 11/16/2022]
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Ling Y, Bhushan S, Fan Q, Tang M. Midterm outcome after surgical correction of anomalous left coronary artery from the pulmonary artery. J Cardiothorac Surg 2016; 11:137. [DOI: doi 10.1186/s13019-016-0535-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Ling Y, Bhushan S, Fan Q, Tang M. Midterm outcome after surgical correction of anomalous left coronary artery from the pulmonary artery. J Cardiothorac Surg 2016; 11:137. [PMID: 27562655 PMCID: PMC5000500 DOI: 10.1186/s13019-016-0535-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/23/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study was undertaken to determine the midterm outcome in patients with anomalous left coronary artery from the pulmonary artery (ALCAPA) undergoing coronary reimplantation and Takeuchi repair. METHODS A retrospective review of patients who had ALCAPA repair between January 2009 and December 2015. Mortality, echocardiography assessment of left ventricular function including ejection fractionand, shortening fraction, severity of mitral regurgitation, stenosis of the coronary ostium were studied retrospectively. RESULTS Sixteen patients were described. The mean age at the time of surgery was 22.5 ± 10.3 years (range, 9 months-35.6 years) and 2 patients were younger than 1 year old, Surgical interventions included left coronary artery reimplantation in 13 patients (81 %) and Takeuchi repair in 3 (19 %). Concomitant mitral valve repair was performed in 2 cases, no cases required mechanical circulatory support postoperatively. There was no mortality. At median follow-up of 4.6 years, EF improved from 33.2 % ±6.8 % to 60.9 % ± 8.1 % (p <0.05), mean SF from 28.5 % ± 12.1 % to 40.2 % ± 5.4 % (p <0.05). Only one patient was with moderate mitral regurgitation. All 16 cases had normal ejection fraction and shortening fraction without stenosis of the coronary ostium at last follow-up. CONCLUSIONS Early establishment of a 2-coronary artery achieved excellent outcomes without morbidity and mechanical circulatory support. Normal ejection fraction and shortening fraction recovered smoothly. There is no stenosis of the coronary ostium at the midterm follow-up.
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Affiliation(s)
- Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Sandeep Bhushan
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qiang Fan
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Menglin Tang
- Department of Intensive Care Unit, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
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Abstract
OBJECTIVES The objectives of this review are to discuss the spectrum of coronary artery anomalies and the evidence behind current treatment strategies. DATA SOURCE MEDLINE and PubMed. CONCLUSION Coronary artery anomalies exist in up to 1% of the population and most of these do not cause symptoms or ischemia and do not require any surgical intervention whereas others are potentially fatal. The type of surgical intervention is often dictated by the type of lesion, and upon the unique anatomic and physiologic variables associated with each lesion. Postoperative care can be challenging particularly after surgical repair of anomalous left coronary artery from the pulmonary artery.
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González-López MT, Cuenca-Peiró V, Castillo-Martín R, Zabala-Argüelles JI, Gil-Jaurena JM. Batista Procedure for a Coronary Anomaly in an Infant: Long-Term Follow-Up. J Card Surg 2016; 31:556-8. [PMID: 27345819 DOI: 10.1111/jocs.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A partial left ventriculectomy (Batista operation) is extremely unusual in infants. Follow-up data are unknown. We report the findings at long-term follow-up in an infant after the Batista procedure, following reimplantation of an anomalous coronary artery. The initial approach and options for management are discussed, along with late cardiac remodeling. doi: 10.1111/jocs.12775 (J Card Surg 2016;31:556-558).
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Affiliation(s)
- María-Teresa González-López
- Department of Pediatric Cardiac Surgery, Gregorio Marañón Hospital, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
| | | | | | | | - Juan-Miguel Gil-Jaurena
- Department of Pediatric Cardiac Surgery, Gregorio Marañón Hospital, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
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Karimi M, Kirshbom PM. Anomalous Origins of Coronary Arteries From the Pulmonary Artery: A Comprehensive Review of Literature and Surgical Options. World J Pediatr Congenit Heart Surg 2016; 6:526-40. [PMID: 26467866 DOI: 10.1177/2150135115596584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anomalous origins of coronary arteries from the pulmonary artery are rare malformations in which the coronary arteries originate from pulmonary artery sinuses or branches. The consequences are variable although, in most cases, these anomalies lead to severe coronary hypoperfusion and ventricular dysfunction. Surgical correction is indicated once the diagnosis is established due to high early mortality associated with the disease. In nearly all cases, the anomalous artery can be excised from its pulmonary origin, mobilized, and reimplanted directly into the ascending aorta using different surgical techniques. In rare circumstances, technical modifications must be used to restore a normal dual coronary perfusion. The emphasis of this article is to provide a collective review of surgical options published in the literature.
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Affiliation(s)
- Mohsen Karimi
- Department of Surgery, Section of Cardiac Surgery, Pediatric Cardiothoracic Surgery, Northeast Pediatric Specialties (NEPS), Yale University School of Medicine, New Haven, Connecticut and Connecticut Children's Medical Center, Hartford, CT, USA
| | - Paul M Kirshbom
- Department of Surgery, Section of Cardiac Surgery, Pediatric Cardiothoracic Surgery, Northeast Pediatric Specialties (NEPS), Yale University School of Medicine, New Haven, Connecticut and Connecticut Children's Medical Center, Hartford, CT, USA
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31
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Naimo PS, Fricke TA, d’Udekem Y, Cochrane AD, Bullock A, Robertson T, Brizard CP, Konstantinov IE. Surgical Intervention for Anomalous Origin of Left Coronary Artery From the Pulmonary Artery in Children: A Long-Term Follow-Up. Ann Thorac Surg 2016; 101:1842-8. [DOI: 10.1016/j.athoracsur.2015.11.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/28/2015] [Accepted: 11/09/2015] [Indexed: 12/11/2022]
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Mongé MC, Eltayeb O, Costello JM, Sarwark AE, Carr MR, Backer CL. Aortic Implantation of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery: Long-Term Outcomes. Ann Thorac Surg 2015; 100:154-60; discussion 160-1. [DOI: 10.1016/j.athoracsur.2015.02.096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
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Cabrera AG, Chen DW, Pignatelli RH, Khan MS, Jeewa A, Mery CM, McKenzie ED, Fraser CD. Outcomes of Anomalous Left Coronary Artery From Pulmonary Artery Repair: Beyond Normal Function. Ann Thorac Surg 2015; 99:1342-7. [DOI: 10.1016/j.athoracsur.2014.12.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 11/20/2014] [Accepted: 12/05/2014] [Indexed: 11/25/2022]
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Quah JX, Hofmeyr L, Haqqani H, Clarke A, Rahman A, Pohlner P, Radford D, Nicolae M. The Management of the Older Adult Patient with Anomalous Left Coronary Artery from the Pulmonary Artery Syndrome: A Presentation of Two Cases and Review of the Literature. CONGENIT HEART DIS 2013; 9:E185-94. [PMID: 23953779 DOI: 10.1111/chd.12125] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jing Xian Quah
- Adult Congenital Heart Disease Unit; The Prince Charles Hospital; Brisbane Qld Australia
| | - Lou Hofmeyr
- Adult Congenital Heart Disease Unit; The Prince Charles Hospital; Brisbane Qld Australia
| | - Haris Haqqani
- Adult Congenital Heart Disease Unit; The Prince Charles Hospital; Brisbane Qld Australia
| | - Andrew Clarke
- Adult Congenital Heart Disease Unit; The Prince Charles Hospital; Brisbane Qld Australia
| | - Atifur Rahman
- Department of Cardiology; Gold Coast Hospital; Southport Qld Australia
| | - Peter Pohlner
- Adult Congenital Heart Disease Unit; The Prince Charles Hospital; Brisbane Qld Australia
| | - Dorothy Radford
- Adult Congenital Heart Disease Unit; The Prince Charles Hospital; Brisbane Qld Australia
| | - Mugur Nicolae
- Adult Congenital Heart Disease Unit; The Prince Charles Hospital; Brisbane Qld Australia
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Georgiev SG, Lazarov SD, Mitev ID, Latcheva AZ, Christov GA, Velkovski IG, Mitev PD. Left ventricular and mitral valve function long after repair of left anomalous coronary artery from the pulmonary artery: recovery years after severe ischemia. World J Pediatr Congenit Heart Surg 2013; 3:321-7. [PMID: 23804864 DOI: 10.1177/2150135111431844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The study evaluates the long-term results of surgery for anomalous left coronary artery from the pulmonary artery (ALCAPA) with special attention on the left ventricular (LV) function and mitral regurgitation. METHODS Twenty-one children underwent surgery for ALCAPA over 23 years (1987-2010). All patients underwent establishment of a two-coronary system, by direct reimplantation (n = 13) or by intrapulmonary tunnel technique (n = 8), with concomitant mitral valve repair in one. The follow-up echocardiograms were evaluated to assess LV function and mitral regurgitation. RESULTS Five patients died. The age of the nonsurvivors was lower, 4.2 ± 1.3 versus 22.7 ± 29.4 months, P = .04. All nonsurvivors had moderate or severe mitral regurgitation preoperatively and higher LV diameter z score than the survivors: 11.8 (9-14.6) versus 4.6 (1.9-13.1), P = .01. At last follow-up, all survivors were asymptomatic; the diastolic LV diameter was normal, with z scores: 0.3 (0.1-1.9) versus 7 (1.9-14.6) preoperatively, P = .001, as was the LV ejection fraction: 66% (61%-78%) versus 38% (16%-70%) preoperatively, P = .001. Fifteen patients had moderate or severe mitral regurgitation at initial presentation and it eventually regressed to insignificant in all survivors (P = .001). No subsequent interventions on the coronary arteries or the mitral valve were needed. Four patients with intrapulmonary tunnel had mild suprapulmonary obstruction with Doppler peak gradients between 20 and 30 mm Hg. CONCLUSIONS In our experience, establishment of a two-coronary circulation without mitral valve repair leads to normalization of LV dimension and systolic function and to improvement of mitral regurgitation in the surviving patients. Mortality is related to low age and to the associated higher degree of LV dysfunction.
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Affiliation(s)
- Stanimir G Georgiev
- Department for Pediatric Cardiology, National Heart Hospital, Sofia, Bulgaria
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Bakhtiary F, Mohr FW, Kostelka M. Midterm outcome after surgical correction of anomalous left coronary artery from pulmonary artery. World J Pediatr Congenit Heart Surg 2013; 2:550-3. [PMID: 23804466 DOI: 10.1177/2150135111413615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early establishment of a two-coronary artery system has become the standard surgical approach in patients with anomalous origin of the left coronary artery from the pulmonary artery. After surgical repair, presentation of severely impaired ventricular function and mitral regurgitation is a common finding. METHODS We reviewed midterm outcome of 18 consecutive patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) undergoing surgical repair for establishment of dual coronary system operated on between September 1999 and July 2009. Mortality, morbidity, echocardiography assessment of left ventricular function, mitral valve regurgitation, and indications for reoperation were studied retrospectively. RESULTS The mean age at the time of surgery was 26 ± 44 months (range, 14 days-12.7 years), 14 patients were younger than 6 months. There was no in-hospital or late mortality. Recovery of left ventricular function was associated with improvement in the degree of mitral valve regurgitation. At the latest follow-up, mitral valve regurgitation was none or trace in 14 patients (78%), mild to moderate in 3 patients (16%), and remained severe in 1 patient (6%). Left ventricular function normalized in 16 patients and remained mildly impaired in 2 patients. Late postoperative echocardiograms demonstrated a patent left coronary artery in 17 patients. In 5 patients temporary left heart bypass (LHB) was needed. CONCLUSIONS Early establishment of a 2-coronary artery system artery results in complete recovery of left ventricular function and without relevant mitral valve dysfunction. Reoperation rates are acceptable. Our results support the use of LHB in patients with refractory low cardiac output. The need of mechanical circulatory support was short and very effective in our patient cohort.
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Affiliation(s)
- Farhad Bakhtiary
- Department of Cardiac Surgery, University of Leipzig, Heart Centre, Leipzig, Germany
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Late complications after Takeuchi repair of anomalous left coronary artery from the pulmonary artery: case series and review of literature. Pediatr Cardiol 2012; 33:1115-23. [PMID: 22438016 DOI: 10.1007/s00246-012-0260-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 02/16/2012] [Indexed: 12/15/2022]
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart lesion that if left untreated, results in high mortality. Surgical treatment options include reimplantation of the anomalous coronary ostia, use of extracardiac arterial blood supply, or the Takeuchi procedure. The Takeuchi procedure involves creation of an aortopulmonary window and an intrapulmonary tunnel that baffles the aorta to the ostium of the anomalous left coronary artery. The incidence of late complications following the Takeuchi repair is unknown. The goal of our study was to determine the long-term outcome after palliation of ALCAPA using the Takeuchi Procedure. A total of 9 patients with a history of ALCAPA palliated with the Takeuchi procedure were identified from our surgical database. Chart review was performed. The mean age at time of Takeuchi procedure was 49.6 months (range 5 weeks-14.6 years). There was one late death, of unknown cause. Of the remaining 8 patients, the mean length of follow-up after surgery was 15.9 years (13.5-19.7 years). All 8 survivors had some degree of main pulmonary artery stenosis in the area of the intrapulmonary baffle, with moderate stenosis in 2 and severe stenosis in 1. Three late survivors (38 %) had a baffle leak. Two patients (25 %) had decreased left ventricular systolic function and 3 (38 %) had developed at least moderate mitral valve regurgitation. Three of the 8 late survivors (38 %) required a reoperation for repair of mitral valve regurgitation, baffle leak, and main pulmonary artery (MPA) stenosis. Review of literature demonstrated similar complication rates and need for reoperation following the Takeuchi procedure. Compared with patients after direct reimplantation for ALCAPA at our institution, there was no significant difference in late survival or freedom from reoperation. The Takeuchi procedure is a method to establish a two-coronary repair for ALCAPA. Late complications are common, necessitating lifelong care in a center experienced with caring for adults with congenital heart disease.
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Makhija Z, Awasthy N, Mohera A, Sharma R, Kaushal S. Spontaneous Resolution of Residual Mitral Regurgitation in Patient With ALCAPA on ECMO. World J Pediatr Congenit Heart Surg 2012; 3:531-3. [PMID: 23804922 DOI: 10.1177/2150135112454147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe a case of revascularization for anomalous left coronary artery from the pulmonary artery (ALCAPA) with severe left ventricular (LV) dysfunction and severe mitral regurgitation (MR). Extracorporeal membrane oxygenation (ECMO), later successfully converted to an indigenous left ventricular assist device (LVAD) functionally resulted in the spontaneous resolution of MR and satisfactory recovery of LV function.
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Affiliation(s)
- Zeena Makhija
- Department of Congenital Cardiac Surgery, Fortis Escorts Heart Research Institute, New Delhi, India
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González López MT, Gil Jaurena JM, Castillo Martín R, Gutiérrez de Loma J. Use of the Batista procedure to discontinue bypass following aortic reimplantation of an anomalous left coronary artery. J Card Surg 2012; 27:114-6. [PMID: 22321115 DOI: 10.1111/j.1540-8191.2011.01389.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A four-month-old infant with anomalous origin of the left coronary artery from the pulmonary artery developed severe left ventricular failure after aortic reimplantation, despite prolonged supportive cardiopulmonary bypass with high level inotropic support and several abortive attempts for discontinuation. The Batista procedure was performed and the patient was successfully weaned from bypass. Postoperative recovery was uneventful, and at one-year follow-up she remains asymptomatic.
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Affiliation(s)
- M T González López
- Cardiovascular Surgery Department, Carlos Haya Regional Hospital, Málaga, Spain.
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Kirbas A, Gurer O, Bilal MS. Intermediate-term results after surgery for anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Cardiovasc Surg 2011; 18:12-7. [PMID: 21921360 DOI: 10.5761/atcs.oa.11.01696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Anomalous origin of the left coronary artery from the pulmonary artery is optimally treated by creating a dual coronary system. Our aim was to review the results of operations performed in these patients and determine the intermediate-term outcomes for left ventricular function and mitral regurgitation. METHODS Between July 2004 and January 2009 seven patients (5 boys, 2 girls) aged between 4 months and 12 years (median, 4.5 years) were operated for anomalous origin of the left coronary artery from the pulmonary artery. The surgical correction was either performed by direct implantation (58%) or restoration of a composite tunnel (42%). Simultaneous mitral annuloplasty was performed in one patient with severe mitral regurgitation and simultaneous total correction of tetralogy of Fallot was performed in another. RESULTS There was no hospital or late deaths. Postoperative echocardiograms demonstrated a significant improvement in the left ventricular ejection fraction (52% ± 6% versus 39% ± 8%, P = 0.02) and mitral regurgitation (11% mild versus 48% moderate, P = 0.02) compared to those obtained preoperatively. CONCLUSION Direct re implantation of the left coronary artery to the aorta and restoration of a composite tunnel from aortic and pulmonary artery walls are equally effective techniques with an acceptable operative mortality, excellent cardiac recovery, and intermediate survival.
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Affiliation(s)
- Ahmet Kirbas
- Department of Cardiovascular Surgery, Medicana Hospitals Camlica, Istanbul, Turkey
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Imamura M, Dossey AM, Jaquiss RD. Reoperation and Mechanical Circulatory Support After Repair of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery: A Twenty-Year Experience. Ann Thorac Surg 2011; 92:167-72; discussion 172-3. [DOI: 10.1016/j.athoracsur.2011.02.074] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 02/14/2011] [Accepted: 02/17/2011] [Indexed: 10/18/2022]
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Alexi-Meskishvili V, Nasseri BA, Nordmeyer S, Schmitt B, Weng YG, Böttcher W, Hübler M, Berger F, Hetzer R. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children. J Thorac Cardiovasc Surg 2011; 142:868-74. [PMID: 21665229 DOI: 10.1016/j.jtcvs.2011.04.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/22/2011] [Accepted: 04/08/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Although mortality after direct aortic reimplantation for anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) has significantly decreased, many questions remain unanswered. METHODS Between 1986 and June 2010, we operated on 27 consecutive pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). All patients underwent reestablishment of a dual coronary system with direct aortic reimplantation of the left coronary artery into the aorta. Postoperative extracorporeal mechanical circulatory support was necessary in 7 cases. In all 7 patients, hemodynamic stability was achieved after 4 to 10 days of support. Mitral valve repair was performed in 9 patients with severe mitral valve incompetence and resulted in stable mitral valve function during follow-up as long as 19 years. RESULTS There were no early or late deaths. During follow-up (3 months-17.5 years), both early and late improvement of myocardial function was observed in all patients. Reduced left ventricular regional function late after successful surgical correction of ALCAPA was related to the presence of left ventricular myocardial scar tissue, as detected by magnetic resonance imaging. CONCLUSIONS Despite the absence of early and late mortality, the long-term prognosis for patients after reimplantation of ALCAPA into the aorta is not clear. Scars and perfusion deficits of the left ventricle may not be detected by standard echocardiographic evaluation of global left ventricular function and therefore may be underestimated. We therefore recommend lifelong surveillance of these patients, including magnetic resonance imaging.
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Mavroudis C, Dodge-Khatami A, Stewart RD, Jacobs ML, Backer CL, Lorber RE. An overview of surgery options for congenital coronary artery anomalies. Future Cardiol 2010; 6:627-45. [DOI: 10.2217/fca.10.82] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Congenital and acquired coronary artery anomalies are associated with significant morbidity and mortality and can be sudden in onset. The spectrum of congenital lesions include anomalous origin from the pulmonary artery, critical left main stenosis/atresia, coronary artery fistulas, anomalous aortic origin and intramyocardial courses. The spectrum of acquired lesions include Kawasaki disease, late postoperative obstructions in patients who had coronary artery surgical manipulations and iatrogenic injuries that can occur in the catheterization laboratory or the operating room. Surgical therapies for ischemic syndromes associated over the long term of these anomalies are presented herein.
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Affiliation(s)
| | - Ali Dodge-Khatami
- Department of Pediatric Cardiac Surgery, University Heart Center Hamburg-Eppendorf University of Hamburg-Eppendorf School of Medicine, Martinistrasse 52, 20246 Hamburg, Germany
| | - Robert D Stewart
- Center for Pediatric & Adult Congenital Heart Diseases, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Marshall L Jacobs
- Center for Pediatric & Adult Congenital Heart Diseases, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Carl L Backer
- Division of Pediatric Cardiovascular-Thoracic Surgery, Department of Surgery, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard E Lorber
- Center for Pediatric & Adult Congenital Heart Diseases, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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44
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Anomalous origin of left main coronary artery from pulmonary artery in an adult: Peri-operative concerns. Indian J Thorac Cardiovasc Surg 2010. [DOI: 10.1007/s12055-010-0018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Hoashi T, Hirsch JC, Bove EL, Ohye RG. Late reoperation after reimplantation of an anomalous single coronary artery from the pulmonary artery. Ann Thorac Surg 2010; 89:285-7. [PMID: 20103259 DOI: 10.1016/j.athoracsur.2009.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 04/28/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
Abstract
A 14-year-old girl with an anomalous origin of a single coronary artery from the pulmonary artery, moderate mitral insufficiency, and an outlet ventricular septal defect, underwent direct reimplantation of the single coronary artery (SCA) to the aorta and closure of the ventricular septal defect at 6 months of age. She had stenosis of the proximal single coronary artery develop 14 years after the initial operation. A patch augmentation of her proximal SCA was successfully performed, and a postoperative coronary angiographic scan taken 3 months after her surgery showed a widely patent SCA without any residual narrowing.
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Affiliation(s)
- Takaya Hoashi
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Novick WM, Li XF, Anic D, Baskevitch A, Sandoval N, Gilbert CL, Di Sessa TG. Anomalous left coronary artery from the pulmonary artery: intermediate results of coronary elongation☆. Interact Cardiovasc Thorac Surg 2009; 9:814-8. [DOI: 10.1510/icvts.2009.208215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Kajihara N, Asou T, Takeda Y, Kosaka Y. Bland-White-Garland syndrome with ventricular septal defect: late presentation. Gen Thorac Cardiovasc Surg 2009; 57:547-9. [PMID: 19830519 DOI: 10.1007/s11748-009-0427-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 02/24/2009] [Indexed: 11/26/2022]
Abstract
Bland-White-Garland syndrome has been reported generally to occur in an isolated lesion. Here, we report a case of Bland-White-Garland syndrome associated with a ventricular septal defect. Late onset of myocardial ischemia was noted in this patient, which we think is related to increased coronary steal due to regression of pulmonary hypertension caused by narrowing of the ventricular septal defect. At surgery, we temporally occluded the left main coronary trunk to cease the coronary steal phenomenon and augment the left coronary flow. Direct implantation of the left coronary artery and closure of the ventricular septal defect were performed. The postoperative course was excellent with no evidence of myocardial ischemia.
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Affiliation(s)
- Noriyoshi Kajihara
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Minami-ku, Yokohama, Japan.
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de Lezo JS, Pan M, Herrera C. Combined percutaneous revascularization and cell therapy after failed repair of anomalous origin of left coronary artery from pulmonary artery. Catheter Cardiovasc Interv 2009; 73:833-7. [PMID: 19180653 DOI: 10.1002/ccd.21891] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This report shows the course of an infant with an abnormal left coronary artery origin arising from the pulmonary artery who underwent failed surgical reimplantation. Treatment entailed combined stent revascularization followed by intracoronary infusion of bone marrow-derived mononuclear cells. The patient was admitted with an acute coronary syndrome and low cardiac output; he was endotracheally intubated under respiratory assistance. Fourteen months after intracoronary infusion of autologous bone marrow-derived mononuclear cells, the infant remains symptom-free with significant recovery of the left ventricular function. These findings suggest that the combination of percutaneous revascularization and cell therapy should be considered in those infants or children in whom salvage therapy for ischemic heart disease is required.
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Affiliation(s)
- José Suárez de Lezo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
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Farouk A, Zahka K, Siwik E, Golden A, Karimi M, Uddin M, Hennein HA. Anomalous Origin of the Left Coronary Artery from the Right Pulmonary Artery. J Card Surg 2009; 24:49-54. [DOI: 10.1111/j.1540-8191.2008.00622.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chiu HH, Wang JK, Chen CA, Chiu SN, Lin MT, Lue HC, Chang CI, Chiu IS, Wu MH. Resolution of pathologic Q wave, left ventricular dysfunction and mitral regurgitation after dual coronary repair of the anomalous origin of the left coronary artery from the pulmonary artery. Eur J Pediatr 2008; 167:1277-82. [PMID: 18317804 DOI: 10.1007/s00431-008-0667-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 01/04/2008] [Indexed: 11/24/2022]
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac defect that usually presents as dilated cardiomyopathy in infancy. From 1984 to 2005, 13 (five males and eight females, 0.13%) out of 9,950 patients with congenital heart disease were identified as ALCAPA at our institute. Corrective surgery was performed at a median age of 9 months (range: 2 months to 5 years). Eleven patients underwent direct reimplantation of the left coronary artery (LCA) to the aorta, while two received extrapulmonary baffling. The overall survival rate was 92%. Only one patient died 5 months after reimplantation of the LCA due to acute myocardial ischaemia. Left ventricular ejection fraction (LVEF) was significantly lower in the eight (62%) patients operated during infancy than in those operated beyond 5 months (median: 35% vs. 75%). Left ventricle function was normalised in 11 patients (85%). Among the eight patients without concomitant mitral annuloplasty, mitral regurgitation (MR) improved to a mild or trivial degree in six patients and remained at the pre-operative level in two patients. Pathologic Q wave was noted in 11 patients, which eventually regressed in all except two cases. The median interval of recovery was 16 days, 6 months and 24 months for MR, LVEF and electrocardiogram (ECG) changes, respectively. In conclusion, ALCAPA is also a rare disease in Asian countries, such as Taiwan. The subsequent recovery of MR, left ventricular (LV) function and even pathologic Q wave can be expected after dual coronary repair, regardless of the age at repair.
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Affiliation(s)
- Hsin-Hui Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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