Korean J Thorac Cardiovasc Surg.  2004 Jan;37(1):19-26.

Surgical Treatment of Anomalous Origin of Coronary Artery from the Pulmonary Artery: Postoperative Changes of Ventricular Dimensions and Mitral Regurgitation

• Kang CH
• Kim WH
• Seo HJ
• Kim JH
• Lee C
• Chang YH
• Hwang SW
• Back MJ
• Oh SS
• Na CY
• Han JJ
• Lee YT
• Kim CW

Abstract

BACKGROUND: The aims of this study are to verify the result of the surgical treatment of ALCAPA and to identify the postoperative changes of left ventricular dimensions and mitral regurgitation (MR). MATERIAL AND METHOD: Fifteen patients operated on since 1985 were included in the study. The patients operated on before 1998 (n=9) showed heterogeneous properties with various surgical strategies and cardiopulmonary bypass techniques. However, six patients were operated on with the established surgical strategy since 1998; 1) Dual perfusion and dual cardioplegic solution delivery through ascending aorta and main pulmonary artery, 2) Coronary transfer by rolled-conduit made of pulmonary artery wall flap, and 3) Additional mitral valvular procedure was not performed. RESULT: Median age of the study group was 6 months (1 month to 34 years). The operative methods were left subclavian artery to left coronary artery anastomosis in 1, simple ligation in 2, Takeuchi operation in 2, and coronary reimplantation in 10 pateints. The mean follow up period was 5.5<5.8 years (2 months 14 years). There were one early death (6.7%) and one late death. Overall 5-year survival rate was 85.6+/-9.6%. The Z-value of left ventricular end-diastolic and end-systolic dimensions were 6.4+/-3.0 and 5.1+/-3.6 preoperatively, and decreased to 1.7+/-1.9 and 0.8+/-1.6 in 3 months (p<0.05). Significant preoperative MR was identified in 6 patients (40%) and all the patients showed immediate improvement of MR within 1 month postoperatively. There were 3 cases of reoperation due to coronary anastomosis site stenosis and recurrence of MR. However, there was no mortality nor late reoperation in the patients operated on after 1998.
CONCLUSION
The surgical treatment of ALCAPA showed favorable survival and early recovery of ventricular dimensions and mitral valvular function. Although long-term reintervention was required in some cases of earlier period, all the cases after 1998 showed excellent surgical outcome without long-term problem.

Keyword

ALCAPA syndrome; Coronary artery anomaly; Mitral valve regurgitation

MeSH Terms

Aorta
Bland White Garland Syndrome
Cardioplegic Solutions
Cardiopulmonary Bypass
Constriction, Pathologic
Coronary Vessels*
Follow-Up Studies
Humans
Ligation
Mitral Valve Insufficiency*
Mortality
Perfusion
Pulmonary Artery*
Recurrence
Reoperation
Replantation
Subclavian Artery
Survival Rate
Cardioplegic Solutions