Background: Direct re-implantation of an anomalous left coronary artery into the aorta is the preferred surgical option for creating a dual coronary arterial system in patients in whom the anomalous artery originated ...Background: Direct re-implantation of an anomalous left coronary artery into the aorta is the preferred surgical option for creating a dual coronary arterial system in patients in whom the anomalous artery originated from the pulmonary trunk. This technique, however, is applicable only when the anomalous ar- tery arises from the left posterior pulmonary sinus. We report the successfully late follow-up of series of patients employing a new technique using combined autogenous aortic and pulmonary endotheliazed tube. Patients and Methods: We have treated 3 patients, aged 2 months, 6 months and 8 months respectively, who presented with anomalous origin of the left coronary artery from the left posterior pulmonary sinus and moderated mitral valve insufficiency by left ventricle dysfunction. We used a trapdoor like coronary artery elongation with autogenous aortic and pulmonary endotheliazed tube to connect the left coronary ostium to ascending aorta, avoiding the mitral valve intervention. Results: There was no early or late death. All patients are in functional class I, with good biventricular function and competent mitral valve at a median follow-up of 94 months, ranged from 108 to 132 months. Postoperative Computerized tomogramphy of aorta in our 1st patient showed good arterial flow, without any distortion. A local and distal stenosis of the left pulmonary artery was observed and submitted to stent treatment. Conclusions: The potential benefits of the trapdoor like and its modification technique are excellent operative exposure. The use of autogenous endothelized tube is a viable tissue capable of further growth, avoidance of injury to the aortic and pulmonary valvar apparatus or production of obstruction within the right ventricular outflow tract.展开更多
Background：Anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） is a rare but potentially life-threatening congenital heart defect. A retrospective analysis was carried out to elucidate t...Background：Anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） is a rare but potentially life-threatening congenital heart defect. A retrospective analysis was carried out to elucidate the surgical outcomes of ALCAPA in infants and children using follow-up echocardiography. Methods： From September 2008 to March 2017, 26 children diagnosed with ALCAPA underwent left coronary re-implantation. All surviving patients received echocardiography during follow-up. Results： The mortality rate after the operation was 11.5%. Before repair, twenty patients （76.9%） presented with left ventricular （LV） dysfunction. The mean Z-score of the preoperative LV end-diastolic diameter was 4.42 ± 2.09. Mitral regurgitation （MR） was present in all patients. Two patients （7.7%）, both with mitral valve prolapse, underwent mitral valve repair at the time of ALCAPA repair. Two children required postoperative extracorporeal membrane oxygenation. LV function normalized at a median time of 5.3 months （range：0.5–36.0 months）. The Z-score of the LV end-diastolic diameter decreased simultaneously. The degree of MR gradually decreased in all surviving patients.All patients had patency of the proximal left coronary artery confirmed by echocardiography at the most recent follow-up. Six patients （26.1%） showed supravalvar pulmonary stenosis and seven patients （30.4%） showed right pulmonary stenosis during follow-up. Conclusions： Coronary re-implantation was effective for rebuilding a dual coronary system in patients with ALCAPA and resulted in progressive improved LV function and reduced functional MR. Echocardiography was valuable for evaluating the outcomes. LV function, the degree of MR, and possible complications could be detected with follow-up echocardiography.展开更多
文摘Background: Direct re-implantation of an anomalous left coronary artery into the aorta is the preferred surgical option for creating a dual coronary arterial system in patients in whom the anomalous artery originated from the pulmonary trunk. This technique, however, is applicable only when the anomalous ar- tery arises from the left posterior pulmonary sinus. We report the successfully late follow-up of series of patients employing a new technique using combined autogenous aortic and pulmonary endotheliazed tube. Patients and Methods: We have treated 3 patients, aged 2 months, 6 months and 8 months respectively, who presented with anomalous origin of the left coronary artery from the left posterior pulmonary sinus and moderated mitral valve insufficiency by left ventricle dysfunction. We used a trapdoor like coronary artery elongation with autogenous aortic and pulmonary endotheliazed tube to connect the left coronary ostium to ascending aorta, avoiding the mitral valve intervention. Results: There was no early or late death. All patients are in functional class I, with good biventricular function and competent mitral valve at a median follow-up of 94 months, ranged from 108 to 132 months. Postoperative Computerized tomogramphy of aorta in our 1st patient showed good arterial flow, without any distortion. A local and distal stenosis of the left pulmonary artery was observed and submitted to stent treatment. Conclusions: The potential benefits of the trapdoor like and its modification technique are excellent operative exposure. The use of autogenous endothelized tube is a viable tissue capable of further growth, avoidance of injury to the aortic and pulmonary valvar apparatus or production of obstruction within the right ventricular outflow tract.
文摘Background：Anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） is a rare but potentially life-threatening congenital heart defect. A retrospective analysis was carried out to elucidate the surgical outcomes of ALCAPA in infants and children using follow-up echocardiography. Methods： From September 2008 to March 2017, 26 children diagnosed with ALCAPA underwent left coronary re-implantation. All surviving patients received echocardiography during follow-up. Results： The mortality rate after the operation was 11.5%. Before repair, twenty patients （76.9%） presented with left ventricular （LV） dysfunction. The mean Z-score of the preoperative LV end-diastolic diameter was 4.42 ± 2.09. Mitral regurgitation （MR） was present in all patients. Two patients （7.7%）, both with mitral valve prolapse, underwent mitral valve repair at the time of ALCAPA repair. Two children required postoperative extracorporeal membrane oxygenation. LV function normalized at a median time of 5.3 months （range：0.5–36.0 months）. The Z-score of the LV end-diastolic diameter decreased simultaneously. The degree of MR gradually decreased in all surviving patients.All patients had patency of the proximal left coronary artery confirmed by echocardiography at the most recent follow-up. Six patients （26.1%） showed supravalvar pulmonary stenosis and seven patients （30.4%） showed right pulmonary stenosis during follow-up. Conclusions： Coronary re-implantation was effective for rebuilding a dual coronary system in patients with ALCAPA and resulted in progressive improved LV function and reduced functional MR. Echocardiography was valuable for evaluating the outcomes. LV function, the degree of MR, and possible complications could be detected with follow-up echocardiography.
