Anomalous origin of the left coronary artery from the pulmonary artery: results of surgical correction in five infants

doi:10.1016/S0003-4975(02)03925-5

The Annals of Thoracic Surgery

Volume 74, Issue 5, November 2002, Pages 1625-1630

https://doi.org/10.1016/S0003-4975(02)03925-5 Get rights and content

Abstract

Background

Five infants operated on for anomalous origin of the left coronary artery from the pulmonary artery were retrospectively analyzed. The mean age at operation was 12 ± 6.7 weeks (95% confidence interval, 3.5 to 20 weeks), and mean weight at operation was 4.43 ± 0.68 kg (95% confidence interval, 3.7 to 5.27 kg). All babies presented in infancy with left ventricular failure. Three had evidence of ischemia with left ventricular strain, and two had Q waves in anterolateral leads on electrocardiograph. Cross-sectional echocardiography showed dilated left ventricles with poor contractility in all babies with fractional shortening of 15.8% ± 4.02% (95% confidence interval, 12% to 20%); moderate mitral regurgitation was seen in all babies.

Methods

All babies underwent operation as soon as the diagnosis was made. Four babies had direct reimplantation of left coronary artery into the aorta, and 1 had tunnel repair. Intraaortic balloon counterpulsation was used in 1 baby for hemodynamic instability and as prophylaxis in the remaining 4 babies postoperatively for 115 ± 26.2 hours (95% confidence interval, 72 to 144 hours).

Results

All babies had delayed closure of the chest. There was no operative mortality. One baby was reoperated on for tunnel stenosis as well as pulmonary stenosis 4 months after primary repair. All babies were followed for 192 patient-months and show an improved fractional shortening.

Conclusions

Early operation, early institution of intraaortic balloon counter pulsation for left ventricular support, and delayed sternal closure are the key to good results.

Section snippets

Material and methods

The case records of 5 consecutive infants presenting to us since 1994 were retrospectively studied. Of these, 4 infants were females and 1 one was male. The patient characteristics and echocardiographic findings are shown in Table 1. All infants presented with signs of LV failure. Three had evidence of ischemia with LV strain on the electrocardiograph, whereas 2 patients had changes of anterolateral infarction. One patient required dobut-amine infusion for hemodynamic instability

Results

There was no operative mortality. The IABP was used for a mean duration of 115.2 ± 26.2 hours (95% confidence interval [CI], 74 to 144 hours). There were no complications related to the insertion of the IABP. It was possible to bring down the enoximone or dobutamine infusion to 5 μg · kg⁻¹ · min⁻¹ soon after the insertion of the balloon in all the patients. In none of the patients was it necessary to prematurely remove the balloon catheter. The chest was kept open for a mean duration of 7.2 ±

Comment

In infants suffering from ALCAPA who had a compromised LV function, age at operation was not a risk factor for mortality as was previously thought 4, 5. Anatomic studies conducted on hearts from babies who died of LV dysfunction secondary to ALCAPA have shown histologic features of chronic ischemia of varying degree. However, the severity of these ischemic changes had no relationship to age at death [6]. With these facts in mind, 5 infants with ALCAPA and compromised LV function were operated

Acknowledgements

The authors thank Tracy Oakes for her secretarial assistance.

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Original article: cardiovascularAnomalous origin of the left coronary artery from the pulmonary artery: results of surgical correction in five infants

Abstract

Background

Methods

Results

Conclusions

Section snippets

Material and methods

Results

Comment

Acknowledgements

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Am Coll Cardiol

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Am Coll Cardiol

Ann Thorac Surg

Ann Thorac Surg

Clinical experience of veno-arterial bypass as a cardiac assist system using centrifugal pump with membrane oxygenator in patients with profound ventricular failure after cardiac surgery

Nippon Geka Gakkai

Original article: cardiovascular
Anomalous origin of the left coronary artery from the pulmonary artery: results of surgical correction in five infants