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[Early surgical correction of the left coronary artery with origin at the pulmonary trunk. Late development]
S L de Almeida1, R Mazzieri, M F Berlinck
1Serviço de Cirurgia Cardiovascular, Beneficøencia Portuguesa, SP.
Insights
Surgical correction of anomalous left coronary artery from the pulmonary artery significantly improves ventricular contractility in infants with heart failure. Early intervention offers a favorable long-term prognosis, enhancing left ventricular function.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Anomalous left coronary artery originating from the pulmonary artery (ALCAPA) is a rare congenital heart defect.
- Infants with ALCAPA often present with severe congestive heart failure refractory to medical management.
Observation:
- Two infants diagnosed with ALCAPA via EKG and coronary angiogram presented with severe heart failure.
- Medical management failed to control symptoms in both cases.
Findings:
- Surgical translocation of the left coronary artery from the pulmonary artery to the aorta was performed.
- Both patients demonstrated a progressive increase in ventricular contractility postoperatively.
- Long-term follow-up (9 and 7 years) showed symptom resolution and excellent clinical condition with preserved ventricular function.
Implications:
- Early surgical correction of ALCAPA is crucial for altering the natural history of the disease.
- Surgical intervention leads to significant recovery of left ventricular function.
- Timely treatment ensures favorable long-term outcomes for affected children.
Abstract:
The report of these two cases show the accentuated and progressive increase in the ventricular contractility in the late postoperative period in patients who underwent surgical correction of left coronary artery with origin at the pulmonary trunk. Male and female infants, both developed congestive heart failure not controlled by medical treatment. The diagnosis was made by EKG and confirmed by coronary angiogram. They were surgically treated by translocation of the left coronary artery from the pulmonary artery to the aorta. Nine and seven years later, respectively both patients are free of symptoms with marked recovery of the left ventricle function without alteration in height and weight and in excellent clinical conditions. The early surgical treatment in these cases, even with unfavourable clinical status is the only way to change the natural history of this pathology, with an increase of the ventricular contractility.