Towards an anatomically correct repair for anomalous left coronary artery arising from the pulmonary trunk
M Muneer Amanullah1, Anthony J Rostron, J R Leslie Hamilton
1Division of Congenital Cardiac Surgery and Congenital Cardiology, The Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Insights
Surgical transfer of anomalous left coronary artery from the pulmonary trunk to the aorta offers excellent long-term outcomes. This life-saving procedure for anomalous origin of the left coronary artery from the pulmonary trunk results in no mortality and low morbidity.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Anomalous origin of the left coronary artery from the pulmonary trunk (ALCAPA) is a rare congenital heart defect with a 1 in 300,000 incidence.
- ALCAPA is life-threatening if not diagnosed and treated early, often presenting in infancy with congestive cardiac failure.
- Patients may require cardiac transplant if left untreated.
Purpose of the Study:
- To investigate the medium-term outcomes of surgical correction for anomalous origin of the left coronary artery from the pulmonary trunk.
- To evaluate the effectiveness of creating a two-coronary arterial circulation in ALCAPA patients.
Main Methods:
- A cohort of 12 patients diagnosed with ALCAPA between 1992 and 2007 underwent aortic reimplantation.
- Surgical techniques included direct reimplantation, tension-free anastomosis with caudally based flaps, extended flaps, and patch arterioplasty.
Main Results:
- No deaths occurred in the studied cohort following surgical correction.
- Left ventricular function recovered in all but one patient.
- All patients experienced a reduction in the severity of mitral regurgitation.
Conclusions:
- Transferring the anomalous left coronary artery to the aorta is the preferred surgical method for ALCAPA.
- Flap creation from the pulmonary trunk and aorta walls facilitates a dual coronary arterial supply.
- This approach ensures long-term patency and adequate blood flow with no mortality and low morbidity.
Background:
Anomalous origin of the left coronary artery from the pulmonary trunk is rare, occurring at an incidence of 1 in 300,000. If not diagnosed and treated early, it is life-threatening. Children with the anomaly usually present in infancy with congestive cardiac failure, and are occasionally referred for cardiac transplant. We investigated the medium term outcome for patients following creation of a two-coronary arterial circulation.
Methods:
Between 1992 and 2007, we diagnosed 15 patients seen at our Institution as having anomalous origin of the left coronary artery from the pulmonary trunk. Over a period of 13 years, aortic reimplantation was undertaken in 12 of these patients, who form the studied cohort.
Results:
Direct reimplantation was performed in 5 patients. In 3 cases, a tension-free anastomosis was created using a caudally based flap. In another 3 cases, an extended flap was used, while a patch arterioplasty was fashioned in the final patient. There were no deaths. Left ventricular function recovered in all but one of the patients, and all patients had a reduction in the degree of mitral regurgitation.
Conclusions:
Among the variety of surgical techniques, transfer of the anomalous left coronary artery to the aorta is the ideal method for long-term patency and adequate blood supply. This can be achieved by creating flaps based on the walls of the pulmonary trunk and aorta, producing a dual coronary arterial supply with no mortality and low morbidity.
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