Résumé
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.
Sujets)
Humains , Aorte , Syndrome de Bland-White-Garland , Vaisseaux coronaires , Échocardiographie , Études de suivi , Cardiopathies congénitales , Ventricules cardiaques , Dispositifs d'assistance circulatoire , Valve atrioventriculaire gauche , Insuffisance mitrale , Artère pulmonaire , Réintervention , Veine saphène , Survivants , Transplants , Fonction ventriculaire , Obstacle à l'éjection ventriculaireRésumé
Berry syndrome (interrupted aortic arch, aortopulmonary window, and aortic origin of right pulmonary artery with intact interventricular septum) is a very rare and complex cardiac malformation. We report a successful one-stage repair in a 14-day-old neonate without circulatory arrest.
Sujets)
Humains , Nouveau-né , Aorte thoracique , Fruit , Cardiopathies congénitales , Artère pulmonaireRésumé
Berry syndrome (interrupted aortic arch, aortopulmonary window, and aortic origin of right pulmonary artery with intact interventricular septum) is a very rare and complex cardiac malformation. We report a successful one-stage repair in a 14-day-old neonate without circulatory arrest.
Sujets)
Humains , Nouveau-né , Aorte thoracique , Fruit , Cardiopathies congénitales , Artère pulmonaireRésumé
Modified Norwood procedure with maintaining cardiac beat was done in a 30-day-old neonate. Procedure was done with regional perfusion of innominate and coronary artery. Postoperative course was uneventful. Second-stage operation (bi-directional cavopulmonary shunt) was done 4 months later. The diameter of ascending aorta was more than 5 mm, Norwood procedure can be done in beating hearts.