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Clinical and hemodynamic course of infants and children with anomalous left coronary artery
R A Hurwitz1, R L Caldwell, D A Girod
1Department of Pediatrics, Indiana University Medical School, Indianapolis.
Insights
Reimplantation of anomalous left coronary artery into the aorta is a successful surgical option. This procedure improves ventricular function and clinical outcomes in patients, including infants, for over 12 years.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- Anomalous left coronary artery (ALCA) is a rare congenital heart defect.
- Surgical intervention is crucial for improving long-term outcomes.
- Reimplantation into the aorta has emerged as a preferred surgical strategy.
Purpose of the Study:
- To evaluate the clinical outcomes of patients with ALCA who underwent aortic reimplantation.
- To assess the impact of surgery on ventricular performance and mitral regurgitation.
- To determine the long-term efficacy of this surgical approach.
Main Methods:
- Retrospective review of 17 patients with ALCA over 20 years.
- Focus on patients who underwent anomalous left coronary artery reimplantation.
- Evaluation of ventricular function, mitral regurgitation, and clinical status post-surgery.
Main Results:
- Eight of nine patients survived reimplantation, with three operated on under 1 year of age.
- Preoperative left ventricular ejection fraction improved significantly from 0.37 to 0.67 (p < 0.001) within 1 year.
- Patients maintained adequate clinical condition for up to 12 years post-operation, with one requiring mitral valvuloplasty.
Conclusions:
- Anomalous left coronary artery reimplantation is a safe and effective surgical treatment.
- Surgery can be successfully performed in infancy, leading to improved ventricular function.
- This approach offers favorable long-term clinical outcomes for patients with ALCA.
Abstract:
The clinical history of all 17 patients with anomalous left coronary artery presenting over the last 20 years was studied, with special emphasis on those who underwent reimplantation of the anomalous coronary artery into the aorta, a procedure that became our "treatment of choice" during this period. These patients were also evaluated for ventricular performance, residual mitral regurgitation, and wall integrity. Early in our experience with reimplantation, two patients died while we waited for them to achieve a more favorable size for surgery. Eight of nine survived reimplantation; three of these were under 1 year of age when operated upon. One of these eight patients has required additional mitral valvuloplasty, but all are doing well clinically up to 12 years after operation. Preoperative left ventricular ejection fraction of 0.37 +/- 0.16 increased to 0.67 +/- 0.07 (p less than 0.001) by 1 year after surgery, despite ventricular wall abnormalities in four patients. Thus reimplantation of the anomalous left coronary artery should be undertaken upon diagnosis, since surgery can be performed successfully in infancy, with resultant improvement in ventricular function and an adequate clinical condition for at least 12 years.