ABSTRACT
BACKGROUND: Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is a very rare congenital heart defect characterized by myocardial ischemia and ultimately scaring. The scar burden will determine eventual recovery of left ventricular function after corrective surgery. MATERIAL METHOD: All patients with proven diagnosis of ALCAPA and who underwent treatment at present centre were included. Detail echocardiography and cardiac magnetic resonance imaging (CMR) (delayed Gadolinium enhancement) was performed before and after surgery. RESULTS: There were 4 patients (3 females, age group 3 months to 3 yr, follow up 6 months to 20 months.) There was no peri operative mortality. All patients had significant improvement in symptom class and LVEF (increase of more than 10%) when evaluated at last follow up. Three patients had pre operative CMR and 3 post operative CMR. All patients had improvement in post operative LVEF, but >50% was observed only in one patient who had less than half thickness delayed gadolinium enhancement. The right coronary flow pattern were unique to disease. The left coronary flow pattern were had significant variation and could predict extent of scared myocardium. CONCLUSION: Ischemia in ALCAPA can lead to myocardial scarring even in early infancy. The recovery in left ventricular function is a closely related to scar burden. Coronary flow patterns are unique and give useful insight into disease process and natural history.
Subject(s)
Bland White Garland Syndrome/diagnosis , Coronary Circulation/physiology , Coronary Vessels/diagnostic imaging , Heart Ventricles/diagnostic imaging , Magnetic Resonance Imaging, Cine/methods , Myocardium/pathology , Pulmonary Artery/diagnostic imaging , Bland White Garland Syndrome/physiopathology , Child, Preschool , Cicatrix/pathology , Coronary Vessels/physiopathology , Female , Follow-Up Studies , Heart Ventricles/physiopathology , Humans , Infant , Male , Pulmonary Artery/abnormalities , Time Factors , Ventricular Function, Left/physiologyABSTRACT
We present a six-year follow-up of an infant who underwent a left subclavian artery to left anterior descending artery anastomosis for anomalous origin of the left coronary artery from the pulmonary artery, without the use of cardiopulmonary bypass. The clinical status, echocardiography, angiography, and exercise tolerance with treadmill test were found to be normal. This technique could be a viable alternative to the more established coronary translocation, with lesser morbidity, shorter hospital stay, and lower economic burden, especially in the developing world.
Subject(s)
Cardiopulmonary Bypass/methods , Coronary Vessel Anomalies/surgery , Coronary Vessels/surgery , Pulmonary Artery/abnormalities , Subclavian Artery/surgery , Vascular Surgical Procedures/methods , Anastomosis, Surgical/methods , Coronary Angiography , Coronary Vessel Anomalies/diagnosis , Coronary Vessels/diagnostic imaging , Echocardiography , Female , Humans , Infant , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgeryABSTRACT
BACKGROUND: Anomalous origin of left coronary artery from pulmonary artery is a very rare disease with incidence of one every 300,000 live births. It has a high mortality of 80% in the first year of life. This observational study summarized our experience using the technique of subclavian arterial bypass without the use of cardiopulmonary bypass (CPB) for treatment of this coronary anomaly in pediatric population. The study aims to revive an earlier technique, with modifications, as an alternative to the existing coronary translocation. METHODS: From 2009 till 2015, six consecutive infants were operated by a single surgeon using subclavian artery to left coronary artery bypass done off pump, to establish a two coronary circulation. RESULTS: Five patients had an improvement in their LV ejection fractions at the time of the last follow-up. Angiography done in two cases after 2 and 6 years after surgery revealed good flow in the left coronary artery and good growth in the length of subclavian artery. There was one surgical mortality in this series. CONCLUSIONS: The technique of off pump subclavian arterial bypass for anomalous origin of the left coronary artery from the pulmonary artery is a viable alternative to the existing standard technique of coronary translocation. It essentially eliminates extracorporeal circulatory support or a left heart bypass that may be needed after coronary translocation. Also, the advantage of avoiding CPB, both in economic terms and also the adverse effects related to use of bypass in this very sick hearts, cannot be disregarded.
Subject(s)
Bland White Garland Syndrome/surgery , Coronary Artery Bypass/methods , Coronary Circulation , Coronary Vessels/surgery , Pulmonary Artery/abnormalities , Bland White Garland Syndrome/diagnosis , Bland White Garland Syndrome/physiopathology , Coronary Angiography , Coronary Vessels/diagnostic imaging , Coronary Vessels/physiopathology , Echocardiography , Female , Follow-Up Studies , Humans , Infant , Male , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Retrospective Studies , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery , Time Factors , Treatment OutcomeABSTRACT
Changes in left coronary artery flow pattern in anomalous left coronary from pulmonary artery can provide valuable insight into pathology and natural history of disease. We wish to discuss a case with pre and post operative left coronary flow pattern with mid term follow up.
ABSTRACT
BACKGROUND: Aortopulmonary window is a rare cardiac anomaly. We report our experience with this rare lesion and highlight the criteria for treating this defect without the use of cardiopulmonary bypass. METHODS: From May 2007 to April 2012, 10 patients, aged 1 to 10 months and weighing 3.4 to 5.5 kg, were operated on by a single surgeon using both off-pump and standard techniques. All patients underwent preoperative and postoperative echocardiographic assessment, and were followed up with clinical examinations and echocardiography. RESULTS: There was no operative death and all patients were alive at the last follow-up. No major morbidities were noted. Two cases were operated on off-pump and they had shorter intensive care unit stays. All patients were in New York Heart Association class I on follow-up, with no residual shunt noted in follow-up echocardiograms. CONCLUSIONS: The surgical closure of aortopulmonary window carries a low surgical risk. Early surgical closure prevents the development of pulmonary vascular disease and achieves good immediate and long-term outcomes. Off-pump repair techniques, when used judiciously, have a place in the treatment of this defect.
