ABSTRACT
BACKGROUND: Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare congenital heart disease. Retrograde flow from the right coronary artery (RCA) through natural collaterals to the low-pressure main pulmonary artery causes extensive ischemia. Limited data concerning the extent of permanent myocardial damage and functional recovery after surgical repair in the long-term follow-up is available. AIM: Determination of the incidence of incipient myocardial dysfunction in ALCAPA patients in the long-term observation using tissue Doppler and speckle tracking echocardiography. METHODS AND RESULTS: Eighteen ALCAPA patients after surgical repair (at median age of 7 months, range 3-167) underwent echocardiographic examination after (median) 17 years. All but 4 patients in NYHA class II presented well at follow-up. No narrowing in proximal LCA was detected in color Doppler. The initial (pre-surgical) left ventricular (LV) ejection fraction of 33±17% almost normalized to 55±6%, but was lower than in the age, sex and body surface area matched control group: 62±5% (p<0.001). At follow-up, LV global longitudinal strain (LS): -15.8±3.3% vs -21.9±1.7%; right ventricular LS: -20.6±3.9% vs -24.9±4.6%; left atrial LS: 27.7±4.3% vs 41.0±11.5%; right atrial LS: 26.8±7.4% vs 44.0±7.9% and early pulsed wave to tissue Doppler mitral filling ratio (E/E'): 8.1±2.6 vs 5.8±1.3 were impaired in the ALCAPA population in comparison to the control group (p<0.01 for all comparisons). LV radial and circumferential strain did not differ between groups. Mean LS in the ALCAPA patients in the RCA region was -19.0±4.4%, while in the LCA region -13.8±7.3% (p<0.00001). CONCLUSIONS: Despite good clinical condition and normalized LV ejection fraction in ALCAPA patients after surgical repair in the long-term follow-up, the diastolic and longitudinal systolic function of all cardiac chambers remained impaired, especially in the LCA region. Lifelong surveillance of repaired ALCAPA patients is needed.
Subject(s)
Anomalous Left Coronary Artery/diagnostic imaging , Coronary Vessels/diagnostic imaging , Heart/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Adolescent , Anomalous Left Coronary Artery/pathology , Anomalous Left Coronary Artery/physiopathology , Anomalous Left Coronary Artery/surgery , Case-Control Studies , Child , Child, Preschool , Coronary Vessels/pathology , Coronary Vessels/physiopathology , Coronary Vessels/surgery , Diastole , Echocardiography, Doppler, Color , Female , Heart/physiopathology , Humans , Infant , Male , Pulmonary Artery/pathology , Pulmonary Artery/physiopathology , Pulmonary Artery/surgery , Pulse Wave Analysis , Stroke Volume , SystoleABSTRACT
The prevalence of asthma has been rising in recent decades. It is the most common disease among pregnant women andaffects ca. 12% of this population. The course of asthma in pregnancy may change. In 1/3 of patients, it worsens; in 1/3 ofpatients, the symptoms are milder; in 1/3 of patients, it remains unchanged. Well-controlled asthma decreases the risk ofpregnancy complications. Uncontrolled and severe asthma increases the risk of congenital malformations and obstetricalcomplications for both mother and baby. Exacerbations may also contribute to poor pregnancy outcomes. These occur mostlyeither in the first or in the second trimester. The most common triggers are viral infections and treatment non-compliance.The key to maintaining and gaining control of asthma is active treatment of asthma and its exacerbations.
