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Improvement of left ventricular function after ligation of the anomalous left coronary artery during infancy
Insights
Simple ligation of anomalous left coronary artery in infants offers long-term survival and good heart function. This surgical approach for anomalous origin of the left coronary artery from the pulmonary artery is effective.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Management
Background:
- Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect.
- Optimal surgical management and timing for symptomatic infants remain controversial.
Purpose of the Study:
- To evaluate the long-term outcomes of simple ligation for ALCAPA in infants.
- To compare ligation with other surgical interventions like bypass grafting.
Main Methods:
- Long-term follow-up of three patients who underwent simple ligation of the anomalous left coronary artery at or before 8 months of age.
- Comparison with one adolescent treated with a saphenous vein bypass graft.
- Assessment of left ventricular contractility and myocardial perfusion using Thallous chloride T1 201 exercise studies.
Main Results:
- Significant improvement in left ventricular contractility observed in patients treated with simple ligation.
- No perfusion abnormalities detected on exercise studies, despite wall-motion abnormalities in two patients.
- Long-term survival with good left ventricular function and minimal symptoms achieved with simple ligation.
Conclusions:
- Simple ligation of the anomalous left coronary artery in infancy can lead to favorable long-term outcomes.
- This approach is effective for patients with ALCAPA and left-to-right shunting.
- It provides a viable alternative to more complex surgical procedures, ensuring good cardiac function.
Abstract:
Considerable controversy surrounds the optimal management of symptomatic infants with anomalous origin of the left coronary artery from the pulmonary artery; this includes the timing and type of surgical intervention. Long-term follow-up was obtained on three patients who had simple ligation of the anomalous left coronary artery at or before 8 months of age; long-term follow-up on an adolescent treated with a saphenous vein bypass graft from the aorta to the coronary artery was available for comparison. Remarkable increase in left ventricular contractility was observed in the three patients treated only by simple ligation of the anomalous left coronary artery during infancy. Thallous chloride T1 201 exercise studies disclosed no perfusion abnormalities in any of the patients despite angiographically demonstrable wall-motion abnormalities in two of the four patients. Our study suggests that simple ligation of the anomalous left coronary artery near its origin in patients with angiographically detectable left-to-right shunting can provide long-term survival with good left ventricular function and minimal clinical complaints.