Repair of Anomalous Single Coronary Artery From the Pulmonary Artery (ASCAPA)

We describe the management of an infant presenting with severe heart failure at 6 weeks of age found to have an anomalous single coronary artery originating from the main pulmonary artery (MPA). This patient was transferred to our hospital and ultimately had their coronary artery translocated to the ascending aorta successfully. Preoperative severe left ventricular (LV) dysfunction and moderate/severe mitral regurgitation (MR) improved to normal function and mild-to-moderate MR 6 weeks postrepair. Three-dimensional CT reconstructions proved valuable and allowed for accurate preoperative planning leading to successful coronary transfer.

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Successful repair of an anomalous right coronary artery arising from the pulmonary artery in a 10 month-old

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1140 ◽

2021 ◽

Vol 2 (3) ◽

Author(s):

Matthew C Schwartz ◽

◽

William Hammill ◽

Thomas S Maxey ◽

◽

...

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Right Coronary Artery ◽

Systolic Function ◽

Main Pulmonary Artery ◽

Left Ventricular Systolic Function ◽

Anterior Wall ◽

Left Ventricular ◽

Normal Left Ventricular ◽

Collateral Network

Echocardiogram (Figure 1A-B) in an asymptomatic 6 month-old raised suspicion for anomalous Right Coronary Artery (RCA) from the Pulmonary Artery (ARCAPA) with retrograde flow from the RCA to the main pulmonary artery. The patient’s left ventricular systolic function was normal. Subsequent cardiac catheterization confirmed the diagnosis as angiography showed that the RCA arose from the anterior aspect of the main pulmonary artery and filled retrograde via a collateral network from the Left Coronary Artery (LCA) system (Figure 1C-D). At 10 months of age, the patient underwent surgical translocation of the RCA to the aorta. On direct visualization, the RCA arose from the anterior wall of the main pulmonary artery and the robust collateral supply of the RCA from the LCA was visualized on the heart’s epicardium (Figure 2). The patient did well and was discharged home several days later. Three months after the operation, the patient continues to do well with normal left ventricular systolic flow and prograde flow into the reimplanted RCA.

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Three-Dimensional Right Ventriculo-Arterial Coupling as an Independent Correlate of Severe Heart Failure Symptoms in Patients with Dilated Cardiomyopathy

10.22541/au.163254704.43778322/v1 ◽

2021 ◽

Author(s):

Aura Vijiiac ◽

Sebastian Onciul ◽

Silvia Deaconu ◽

Radu Vatasescu ◽

Claudia Guzu ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Artery ◽

Right Ventricular ◽

Dilated Cardiomyopathy ◽

Three Dimensional ◽

Severe Heart Failure ◽

Systolic Pressure ◽

Left Ventricular ◽

Pulmonary Artery Systolic Pressure ◽

Characteristic Analysis

Background: Right ventricular-pulmonary artery coupling (RVPAC) is a predictor of outcome in pulmonary hypertension. However, the role of this parameter in dilated cardiomyopathy (DCM) remains to be established. The aim of this study was to assess the contribution of RVPAC to the occurrence of severe heart failure (HF) symptoms in patients with DCM using three-dimensional (3D) echocardiography. Methods: We prospectively screened 139 outpatients with DCM, 105 of whom were enrolled and underwent 3D echocardiographic assessment. RVPAC was estimated non-invasively as the 3D right ventricular stroke volume (SV) to end-systolic volume (ESV) ratio. Severe HF symptoms were defined by New York Heart Association (NYHA) class III or IV. We evaluated differences in RVPAC across NYHA classes and the ability of RVPAC to predict severe symptoms. Results: Mean left ventricular (LV) ejection fraction was 28±7%. Mean RVPAC was 0.77±0.30 and it was significantly more impaired with increasing symptom severity (p=0.001). RVPAC was the only independent correlate of severe HF symptoms, after adjusting for age, diuretic use, LV systolic function, LV diastolic function and pulmonary artery systolic pressure (OR 0.035 [95% CI, 0.004 – 0.312], p=0.003). By receiver-operating characteristic analysis, the RVPAC cut-off value for predicting severely symptomatic status was 0.54 (area under the curve=0.712, p<0.001). Conclusion: 3D echocardiographic SV/ESV ratio is an independent correlate of severe HF symptoms in patients with DCM. 3D RVPAC might prove to be a useful risk stratification tool for these patients, should it be further validated in larger studies.

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Single coronary artery with a fistula to the main pulmonary artery in a patient with tetralogy of Fallot

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(19)41475-x ◽

1977 ◽

Vol 73 (5) ◽

pp. 738-741 ◽

Cited By ~ 8

Author(s):

Joel I. Brenner ◽

Lawrence R. Burwell ◽

Marius M. Hubbell ◽

Maury C. Newton ◽

L. Jerome Krovetz ◽

...

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Tetralogy Of Fallot ◽

Main Pulmonary Artery ◽

Single Coronary Artery

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Repair of Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA) beyond Infancy

The Heart Surgery Forum ◽

10.1532/hsf98.20131008 ◽

2013 ◽

Vol 16 (4) ◽

pp. 210 ◽

Cited By ~ 2

Author(s):

Sachin Talwar ◽

Aandrei Jivendra Jha ◽

Shiv Kumar Choudhary ◽

Saurabh Kumar Gupta ◽

Balram Airan

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Respiratory Tract ◽

Left Coronary Artery ◽

Nyha Class ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Anomalous Left Coronary Artery ◽

Tract Infections ◽

Anomalous Left Coronary

Between January 2002 and December 2012, five patients (4 female) underwent corrective surgery for anomalous left coronary artery from pulmonary artery (ALCAPA). They were older than 1 year (range, 3-56 years). One of the 2 patients younger than 10 years had presented with congestive heart failure, and the other had experienced repeated episodes of lower respiratory tract infection since childhood. Of the remaining 3 adult patients, 2 had experienced angina with effort, and 1 patient had had repeated respiratory tract infections since childhood, with mild dyspnea on effort of New York Heart Association (NYHA) class II. Three patients had the anomalous left coronary artery implanted directly into the ascending aorta via coronary-button transfer, and 2 patients underwent coronary artery bypass with obliteration of the left main ostium. Two patients underwent concomitant mitral valve repair procedures, and 1 patient underwent direct closure of a perimembranous ventricular septal defect. Four patients survived the surgery, and 1 patient died because of a persistently low cardiac output. Follow-up times ranged from 3 months to 4 years. All survivors are in NYHA class I and have left ventricular ejection fractions of 45% to 60%, with moderate (n = 1), mild (n = 1), or no (n = 2) mitral insufficiency. We conclude that a few naturally selected patients with ALCAPA do survive beyond infancy and can undergo establishment of 2 coronary systems with satisfactory results.

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Outcomes of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children

Cardiology in the Young ◽

10.1017/s104795112100161x ◽

2021 ◽

pp. 1-6

Author(s):

Tong Feng ◽

Guo Zhangke ◽

Bai Song ◽

Fan Fan ◽

Zhen Jia ◽

...

Keyword(s):

Coronary Artery ◽

Mitral Regurgitation ◽

Ejection Fraction ◽

Pulmonary Artery ◽

Left Coronary Artery ◽

Surgical Repair ◽

Left Ventricular ◽

Anomalous Origin ◽

Dimension Index

Abstract Objectives: Anomalous origin of the left coronary artery from the pulmonary artery is associated with high mortality if not timely surgery. We reviewed our experience with anomalous origin of the left coronary artery from the pulmonary artery to assess the preoperative variables predictive of outcome and post-operative recovery of left ventricular function. Methods: A retrospective review was conducted and collected data from patients who underwent anomalous origin of the left coronary artery from the pulmonary artery repair at our institute from April 2005 to December 2019. Left ventricular function was assessed by ejection fraction and the left ventricular end-diastolic dimension index. The outcomes of reimplantation repair were analysed. Results: A total of 30 consecutive patients underwent anomalous origin of the left coronary artery from the pulmonary artery repair, with a median age of 14.7 months (range, 1.5–59.6 months), including 14 females (46.67%). Surgery was performed with direct coronary reimplantation in 12 patients (40%) and the coronary lengthening technique in 18 (60%). Twelve patients had concomitant mitral annuloplasty. There were two in-hospital deaths (6.67%), no patients required mechanical support, and no late deaths occurred. Follow-up echocardiograms demonstrated significant improvement between the post-operative time point and the last follow-up in ejection fraction (49.43%±19.92% vs 60.21%±8.27%, p < 0.01) and in moderate or more severe mitral regurgitation (19/30 vs 5/28, p < 0.01). The left ventricular end-diastolic dimension index decreased from 101.91 ± 23.07 to 65.06 ± 12.82 (p < 0.01). Conclusions: Surgical repair of anomalous origin of the left coronary artery from the pulmonary artery has good mid-term results with low mortality and reintervention rates. The coronary lengthening technique has good operability and leads to excellent cardiac recovery. The decision to concomitantly correct mitral regurgitation should be flexible and be based on the pathological changes of the mitral valve and the degree of mitral regurgitation.

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ORIGIN OF THE LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY WITHOUT COLLATERAL CIRCULATION

PEDIATRICS ◽

10.1542/peds.32.4.588 ◽

1963 ◽

Vol 32 (4) ◽

pp. 588-593

Author(s):

Robert M. Armer ◽

Harris B. Shumacker ◽

Paul R. Lurie ◽

Charles Fisch

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Collateral Circulation ◽

Left Coronary Artery ◽

Main Pulmonary Artery ◽

Coronary Ostium ◽

Coronary Insufficiency ◽

Electrocardiographic Findings ◽

Patch Graft ◽

Painful Shock

A 4-month-old infant with repeated painful shock-like episodes was shown by the progression of electrocardiographic findings to have coronary insufficiency and finally a myocardial infarction. Selective cineangio-cardiography demonstrated anomalous origin of the left coronary artery from the main pulmonary artery with flow from the pulmonary artery to the myocardium. Preparations for surgical transplantation to the aorta were being made when the infant died. The feasibility of the proposed operation was demonstrated post mortem. A segment of the main pulmonary artery was excised with the coronary ostium at its base and converted into a tube which was anastomosed to the aorta. The defect in the pulmonary artery was repaired with a patch graft of Dacron.

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Comparison of Myocardial Infarction with Sequential Ligation of the Left Anterior Descending Artery and Its Diagonal Branch in Dogs and Sheep

The International Journal of Artificial Organs ◽

10.1177/039139880302600411 ◽

2003 ◽

Vol 26 (4) ◽

pp. 351-357 ◽

Cited By ~ 10

Author(s):

W.G. Kim ◽

Y.C. Shin ◽

S.W. Hwang ◽

C. Lee ◽

C.Y. Na

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Pulmonary Artery ◽

Left Ventricular ◽

Coronary Artery Ligation ◽

Suitable Model ◽

Artery Ligation ◽

Diagonal Branch ◽

Left Anterior Descending Artery ◽

Arterial Blood

We report a comparison of the effects of myocardial infarction in dogs and sheep using sequential ligation of the left anterior descending artery (LAD) and its diagonal branch (DA), with hemodynamic, ultrasonographic and pathological evaluations. Five animals were used in each group. After surgical preparation, the LAD was ligated at a point approximately 40% of the distance from the apex to the base of the heart, and after one hour, the DA was ligated at the same level. Hemodynamic and ultrasonographic measurements were performed preligation, 30 minutes after LAD ligation, and 1 hour after DA ligation. As a control, two animals in each group were used for the simultaneous ligation of the LAD and the DA. Two months after the coronary ligation, the animals were evaluated as previously, and killed for postmortem examination of their hearts. All seven animals in the dog group survived the experimental procedures, while in the sheep group only animals with sequential ligation of the LAD and DA survived. Statistically significant decreases in systemic arterial blood pressure and cardiac output, and an increase in the pulmonary artery capillary wedge pressure (PACWP) were observed one hour after sequential ligation of the LAD and its DA in the sheep, while only systemic arterial pressures decreased in the dog. Ultrasonographic analyses demonstrated variable degrees of anteroseptal dyskinesia and akinesia in all sheep, but in no dogs. Data two months after coronary artery ligation showed significant increases in central venous pressure, pulmonary artery pressure, and PACWP in the sheep, but not in the dog. Left ventricular end-diastolic dimension and left ventricular end-systolic dimension in ultrasonographic studies were also increased only in the sheep. Pathologically, the well-demarcated thin-walled transmural anteroseptal infarcts with chamber enlargement were clearly seen in all specimens of sheep, and only-mild-to-moderate chamber enlargements with endocardial fibrosis were observed in the dog hearts. In conclusion, this study confirms that the dog is not a suitable model for myocardial infarction with failure by coronary artery ligation despite negligent operative mortality, when compared directly with an ovine model.

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