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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
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Surgical management of coronary artery arising from the wrong coronary sinus, using standard and novel approaches

Rajeev Gulati1, Vadiyala Mohan Reddy, Casey Culbertson

  • 1Department of Pediatric Cardiac Surgery, Stanford University Medical Center, Stanford, Calif, USA. rgulati@alumni.duke.edu

The Journal of Thoracic and Cardiovascular Surgery
|November 3, 2007
PubMed

Insights

Surgical repair of anomalous coronary arteries originating from the wrong sinus can prevent sudden death. Pulmonary artery translocation is effective for single ostium without intramural course, avoiding coronary artery bypass grafting.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Anomalous coronary artery origin from the wrong aortic sinus poses a risk of ischemia and sudden cardiac death.
  • High-risk features include interarterial course, intramural course, or abnormal orifice.
  • Conventional surgical options like unroofing, reimplantation, or coronary artery bypass grafting are suboptimal for certain anatomical variants.

Purpose of the Study:

  • To evaluate the efficacy of surgical repair strategies for anomalous coronary arteries originating from the wrong sinus.
  • To introduce and assess pulmonary artery translocation as a treatment for single coronary ostium without intramural course.

Main Methods:

  • Retrospective review of 18 pediatric patients (mean age 8.1 years) with anomalous coronary arteries between 1999 and 2005.
  • Surgical interventions included unroofing (n=11), reimplantation (n=3), and pulmonary artery translocation (n=4).
  • All patients underwent clinical and echocardiographic follow-up.

Main Results:

  • No mortality occurred during a mean follow-up of 2.2 years.
  • Symptomatic improvement and normal cardiac function were observed in most patients.
  • One patient required heart transplantation due to multiple infarcts despite surgical repair.

Conclusions:

  • Surgical repair is indicated for patients with coronary insufficiency and asymptomatic individuals with high-risk anatomical abnormalities.
  • Recommended techniques include unroofing for intramural components, reimplantation for separate ostia without intramural course, and pulmonary artery translocation for single ostium without intramural course.
  • These approaches effectively avoid the need for coronary artery bypass grafting.
Abstract

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