Adult-Type Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Syndrome

Hellenic Journal of Surgery - Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare cardiac malformation accounting for 0.25% of congenital heart diseases with...     

Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery in an Adult: Tubular Reconstruction of the Left Main Coronary Artery Under Coronary Perfusion

A bstract A 38-year-old female with anomalous origin of the left coronary artery (LCA) from pulmonary artery was surgically corrected by tubular reconstruction of the left main coronary artery (LMCA) using the pulmonary artery wall, and this repair was performed under beating heart. Thus, the pulmonary artery was divided above the orifice level and just above the pulmonary valve, and the commissure between nonfacing and left side sinuses was dissected away from the pulmonary artery wall to obtain lateral flaps. The pulmonary artery defect was reconstructed with a roll using an autologous pericardial patch, while the detached commissure was suspended on the pericardial patch. The long tube constructed using pulmonary artery tissue was anastomosed to the anterior aspect of the ascending aorta. These procedures were performed under beating heart simply by clamping the LMCA, since the preoperative myocardial contrast echocardiography confirmed the adequate coronary collateral flow from the right circulation. The postoperative course was uneventful, and a coronary artery angiogram demonstrated a widely patent LMCA. Our experience suggests that, in adult cases, this procedure could be performed without myocardial ischemia simply by clamping the LMCA because of well-developed coronary collateral arteries. The safety of this technique could be confirmed by myocardial contrast echocardiography.     

Anomalous Origin of the Left Coronary Artery from the Right Pulmonary Artery

Abstract   Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare congenital anomaly, one which requires a high index of suspicion in order to be diagnosed promptly and managed accurately. ALCAPA from the right branch pulmonary artery (RPA) is a small subset of ALCAPA in general, with only a few reported cases in the world literature. We report two cases of ALCAPA from the RPA: the first case, an infant, presented in severe cardiac failure requiring preoperative extracorporeal membrane oxygenation (ECMO) for stabilization; and the second, a neonate, presented with severe aortic coarctation (CoA). Both patients underwent successful complete surgical repair using a modified surgical technique, and are doing well in midterm follow-up. We describe our operative technique and review the literature of this rare congenital anomaly.     

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Adults

Between March 1986 and December 1994, four adult patients underwent surgery for anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) at the German Heart Institute Berlin. The patients, aged 27, 35, 54, and 60, were all females. ALCAPA was diagnosed 3 to 8 months before surgery. The patients presented with cardiac murmur (two patients), abnormal ECG pattern (two patients), arrhythmia (one patient), and acute myocardial infarction (one patient). During surgery a two coronary system was established either by Takeuchi operation (one patient), interruption of the anomalous vessel and aortocoronary saphenous vein bypass (two patients), or internal mammary artery bypass (one patient). There were no postoperative deaths, however, one patient had to be reoperated because of a recurrent shunt. Clinical improvement was observed in all four patients with disappearance of fatigue, angina, dyspnea, and ischemic ECG changes. Despite having this long-standing congenital heart defect, adult and elderly patients with ALCAPA may benefit from surgical intervention to establish a two coronary system.     

左冠状动脉异常起源于肺动脉的外科治疗

１例患左冠状动脉异常起源于动脉的７岁女孩，行左冠状动脉的重建术获得成功。因异常起源的左冠状动脉源于肺脉的主干左后侧，右冠状主干较，不能直接植入升主动脉；病儿年龄小，大隐静脉和其他自体血管难以利用，故采用人工血管左冠状动脉旁路架桥术。术后病儿恢复顺利，研室功能正常，心血管造景证实人工血管桥和左冠状动脉 通畅、无狭窄或扭曲。作者认为，在左冠状动脉异常起源于肺动脉的病人，当左冠状动脉不能直接植入升主动脉     

Surgical Correction of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) Is a rare congenital anomaly seen in 0.26% of all congenital heart defects. From 1978 to the present, we have encountered 11 such cases in patients ranging from 3 months to 60 years of age. A variety of procedures have been performed, such as ligation of the anomalous left coronary artery (n = 1), saphenous vein bypass (n = 2), subclavian to left coronary artery anastomosis (n = 4), Takeuchl repair (n = 1), and revascularizatlon using a 6-mm Gore-Tex tube (n = 1). No of these patients were children who also had prosthetic mitral valve replacements with a #1 M Starr-Edwards valve and left subclavian to left coronary artery anastomosis. Three patients died postoperatively, one Immediately after surgery due to low cardiac output, another on the eighth postoperative day due to renal failure, and the third was a child who died 3 months later due to bacterial endocarditis of the prosthetic valve. The surviving patients have been and are in NYHA Class I after a mean follow-up of 9 years. One patient, revascularized with a prosthetic graft, was lost for follow-up after 3 years. A two-coronary system appears more physiological and Is reported to be favored by most surgeons. Left subclavian to left coronary artery anastomosis has also been observed to give excellent results, with which we also agree. The mitral valve replacement In addition to this procedure, reported here, has not been described before in the literature.