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

2013 ◽  
Vol 16 (4) ◽  
pp. 210 ◽  
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.

Effective myocardial perfusion and concomitant haemodynamic status determine the clinical diversity of anomalous left coronary artery from the pulmonary artery

2020 ◽  
Vol 30 (3) ◽  
pp. 362-368
Author(s):  
Amr A. Matoq ◽  
Takeshi Tsuda
Keyword(s):  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Surgical Repair ◽  
Systolic Function ◽  
Left Ventricular ◽  
Retrograde Flow ◽  
Anomalous Left Coronary Artery ◽  
Anomalous Left Coronary

AbstractBackground:Anomalous left coronary artery from the pulmonary artery is a rare congenital heart disease (CHD) with diverse clinical presentations despite the same anatomy. Factors determining this heterogeneous presentation are not well understood.Method and Results:We retrospectively investigated 14 patients (12 females) who underwent surgical repair of anomalous left coronary artery from the pulmonary artery. These patients were divided into three groups based upon the severity of initial presentation: (1) severe, life-threatening condition (n = 5), (2) mild-to-moderate distress (n = 6), and (3) asymptomatic (n = 3). All patients presented with left ventricular dilation and retrograde flow in left coronary artery by echocardiogram. Eight patients in (1) and (2) presented with severe left ventricular dysfunction. All but one showed abnormal ECG consistent with myocardial ischemia or infarction. Asymptomatic patients had preserved left ventricular systolic function despite ischemic findings on ECG. In 13 patients after surgical repair, all but one normalised left ventricular geometry and systolic function, suggesting nearly full myocardial recovery upon improvement of myocardial perfusion; 8 patients had residual echogenic papillary muscle with variable degree of mitral regurgitation.ConclusionsEvidence of myocardial ischemic injury was present in all patients with anomalous left coronary artery from the pulmonary artery regardless of their initial presentation. Retrograde flow in left coronary artery, implying collateral vessel development from right coronary artery to left coronary artery, was noted in all patients, yet only few patients had preserved systolic function at the time of diagnosis. The balance between effective myocardial perfusion and a deleterious fistulous flow provided by these collaterals and the simultaneous haemodynamic status are what determine the clinical diversity of anomalous left coronary artery from the pulmonary artery.

Anomalous left coronary artery from the pulmonary artery discovered following total anomalous pulmonary venous return repair: a rare entity

2016 ◽  
Vol 27 (2) ◽  
pp. 385-387
Author(s):  
Neil D. Patel ◽  
Sarah Badran ◽  
Grace Kung
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Ventricular Dysfunction ◽  
Venous Return ◽  
Left Ventricular ◽  
Anomalous Left Coronary Artery ◽  
Anomalous Pulmonary Venous Return ◽  
Anomalous Left Coronary

AbstractWe describe a case of anomalous left coronary artery from the pulmonary artery in association with total anomalous pulmonary venous return. The infant was diagnosed with total anomalous pulmonary venous return at 6 weeks of age and underwent successful surgical repair. On routine follow-up, he was found to have an anomalous left coronary artery from the pulmonary artery without evidence of mitral regurgitation or left ventricular dysfunction. The presence of the left-to-right shunt and secondary elevation in pulmonary artery pressures likely masked the usual findings associated with this coronary anomaly.

Two-Coronary Repair for Anomalous Left Coronary Artery from Pulmonary Artery

2000 ◽  
Vol 8 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Sachin Talwar ◽  
Anil Bhan ◽  
Rajesh Sharma ◽  
Shiv Kumar Choudhary ◽  
Balram Airan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Left Ventricular ◽  
Long Term Results ◽  
Anomalous Left Coronary Artery ◽  
Low Cardiac Output ◽  
Anomalous Artery ◽  
Anomalous Left Coronary

Between January 1989 and December 1998, 13 patients (7 males) aged 3 months to 32 years, underwent surgery for anomalous left coronary artery from the pulmonary artery. Eight presented with congestive cardiac failure and all had evidence of left ventricular dysfunction. One patient had associated tetralogy of Fallot. Preoperative diagnosis was established by echocardiography and cineangiography. Nine patients underwent Takeuchi repair and 4 had direct implantation of the anomalous artery into the aorta. There were 2 postoperative deaths due to low cardiac output. In survivors, serial echocardiograms demonstrated significant improvement in left ventricular function 3 months to 10 years after surgery. Postoperative angiograms in 4 patients showed a patent aortocoronary tunnel in 3 who underwent Takeuchi repair and a patent aortocoronary anastomosis in one who had direct implantation of the anomalous artery into the aorta. It was concluded that early establishment of a two-coronary system gave gratifying short-term and long-term results.

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