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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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A combined approach to correct posterior left ventricular aneurysm, aortic stenosis and coronary artery disease

Akshay J Patel1, Saifullah Mohamed2, Yassir Iqbal3

  • 1Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK.

Journal of Surgical Case Reports
|October 19, 2020
PubMed

Insights

This case study details a complex surgical repair for simultaneous ischaemic heart disease, aortic stenosis, and left ventricular aneurysm. The successful procedure restored cardiac function and prevented embolic stroke risks.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Pathology

Background:

  • Ischaemic heart disease and aortic stenosis pose significant risks.
  • A post-infarct left ventricular aneurysm exacerbates these dangers, creating a hazardous triad.

Observation:

  • A patient presented with simultaneous ischaemic heart disease, aortic stenosis, and a left ventricular aneurysm.
  • This combination presents a unique and severe clinical challenge.

Findings:

  • Surgical correction involved aneurysmectomy, aortic valve replacement, and coronary artery bypass grafting.
  • Teflon-buttressed mattress sutures achieved direct linear closure of the aneurysm.
  • Post-operative assessment showed good ventricular systolic function (LVEF 40%) and a competent aortic valve without paravalvular leaks.

Implications:

  • Meticulous aneurysm thrombectomy and edge eversion are crucial to prevent embolic stroke.
  • Restoring ventricular shape is vital for effective myocardial function and adequate stroke volume.
  • This case demonstrates a viable surgical strategy for complex cardiac conditions.

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