ABSTRACT
Introducción y objetivos. Describir nuestra experiencia en la corrección quirúrgica del origen anómalo de la arteria coronaria izquierda del tronco de la arteria pulmonar (ALCAPA), con énfasis en la técnica del reimplante coronario y sus resultados. Métodos. Se realizó un estudio descriptivo, longitudinal y retrospectivo de los pacientes con ALCAPA operados con técnica de reimplante coronario en un periodo de 19 años. Se exponen tres técnicas del reimplante coronario, dependiendo de la situación de la coronaria izquierda anómala, y la evolución postoperatoria en términos de morbimortalidad. Resultados. Se analizó a 15 pacientes (el 86% mujeres) con una media de edad de 6,2 años (2 meses-24 años). El 80% se hospitalizó por insuficiencia cardiaca. El 67% tenía disfunción ventricular izquierda y el 27%, insuficiencia mitral importante o grave. Se practicó cirugía valvular mitral concomitante en 4 pacientes. Las principales complicaciones postoperatorias inmediatas fueron bajo gasto cardiaco (38%), derrame pleural (17%) e isquemia transitoria (13%). No hubo mortalidad operatoria ni a medio plazo. Conclusiones. El reimplante coronario es la opción quirúrgica de elección para el manejo de los pacientes con ALCAPA por su excelente supervivencia posquirúrgica y su baja morbilidad operatoria (AU)
Introduction and objectives. We report our experience in the surgical correction of anomalous origin of left coronary artery from pulmonary artery (ALCAPA), with an emphasis on the coronary reimplantation technique and its outcome. Methods. We designed a retrospective, longitudinal, descriptive study that included patients with ALCAPA who underwent surgery involving coronary reimplantation over a 19-year period. We describe perioperative details such as variations in the surgical technique and the postoperative outcome in terms of morbidity and mortality. Results. We studied 15 patients (86% females) with a mean age of 6.2 years (range, 2 months to 24 years). Heart failure was the principal cause for hospitalization in 80% of our patients. Left ventricular dysfunction was present in 67%, and 27% had significant or severe mitral valve regurgitation. We describe 3 surgical techniques for coronary reimplantation, the choice of which depends on the site of origin of the anomalous left coronary artery. Four patients underwent an additional mitral valve procedure. The most common immediate postoperative complications were low cardiac output (38%), pleural effusion (17%), and transient ischemia (13%). There was no operative or medium-term mortality. Conclusions. Coronary reimplantation is the technique of choice for surgical correction of ALCAPA due to the excellent postoperative survival and low operative morbidity (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Adult , Pulmonary Artery/surgery , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/surgery , Heart Failure/surgery , Postoperative Complications/therapy , Sternotomy/methods , Catheterization/methods , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/surgery , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital , Retrospective Studies , Indicators of Morbidity and Mortality , Anastomosis, Surgical/methods , 28599 , Radiography, Thoracic/methods , Mitral Valve InsufficiencyABSTRACT
INTRODUCTION AND OBJECTIVES: We report our experience in the surgical correction of anomalous origin of left coronary artery from pulmonary artery (ALCAPA), with an emphasis on the coronary reimplantation technique and its outcome. METHODS: We designed a retrospective, longitudinal, descriptive study that included patients with ALCAPA who underwent surgery involving coronary reimplantation over a 19-year period. We describe perioperative details such as variations in the surgical technique and the postoperative outcome in terms of morbidity and mortality. RESULTS: We studied 15 patients (86% females) with a mean age of 6.2 years (range, 2 months to 24 years). Heart failure was the principal cause for hospitalization in 80% of our patients. Left ventricular dysfunction was present in 67%, and 27% had significant or severe mitral valve regurgitation. We describe 3 surgical techniques for coronary reimplantation, the choice of which depends on the site of origin of the anomalous left coronary artery. Four patients underwent an additional mitral valve procedure. The most common immediate postoperative complications were low cardiac output (38%), pleural effusion (17%), and transient ischemia (13%). There was no operative or medium-term mortality. CONCLUSIONS: Coronary reimplantation is the technique of choice for surgical correction of ALCAPA due to the excellent postoperative survival and low operative morbidity.
