Korean J Thorac Cardiovasc Surg.
2005 Aug;38(8):523-528.
Changes of Ventricular Function and Mitral Regurgitation after Repair of Anomalous Origin of Coronary Artery from the Pulmonary Artery
- Affiliations
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- 1Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine. jrl@plaza.snu.ac.kr
- 2Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine.
- 3Seoul National University Hospital, Medical Research Institute Xenotransplantation Research Center.
Abstract
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BACKGROUND: Investigation of the change of ventricular function and mitral regurgitation after surgical repair of patient with anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is key issue for the better surgical outcome.
MATERIAL AND METHOD: From April 1986 to July 2002, 12 patients presented with ALCAPA. The median age at repair was 4 months. Surgical methods included left coronary artery transfer to the aorta (10), Takeuchi procedure (1), saphenous vein free graft bypass (1). Mitral valve was repaired in 1.
RESULT: There were 2 hospital death (16.7%). The mean follow-up period was 7.1+/-4.1 years (range, 7 months to 13 years). Four patients required postoperative circulatory assist for 2.2+/-1.1 days and one needed left ventricular assist device (LVAD) for 1day. Postoperative echocardiography demonstrated significant improvements in mean fractional shortening (33.4+/-9.1% vs 17.7+/-9.6%, n=10, p<0.05); left ventricular end diastolic dimension (33.1+/-7.3 mm vs 41.8+/-7.0 mm, n=10, p<0.05) and systolic dimension (22.2+/-7.5 mm vs 33.4+/-7.9 mm, n=10, p<0.05). Severities of mitral regurgitation decreased in all survivors at 1st and 4th year follow-up echocardiography. There were 2 reoperation due to residual MR and right ventricular outflow obstruction (Takeuchi case).
CONCLUSION
Anatomic repair of anomalous left coronary artery from the pulmonary artery offered an excellent surgical results, especially in terms of the recovery of left ventricle function and mitral regurgitation. However, preoperative indications for mitral procedure is to be evaluated.
MeSH Terms
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Aorta
Bland White Garland Syndrome
Coronary Vessels*
Echocardiography
Follow-Up Studies
Heart Defects, Congenital
Heart Ventricles
Heart-Assist Devices
Humans
Mitral Valve
Mitral Valve Insufficiency*
Pulmonary Artery*
Reoperation
Saphenous Vein
Survivors
Transplants
Ventricular Function*
Ventricular Outflow Obstruction
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