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Outcomes of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children

Part of: Surgery

Published online by Cambridge University Press:  28 April 2021

Tong Feng
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
Guo Zhangke
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
Bai Song
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
Fan Fan
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
Zhen Jia
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
Li Xiaofeng*
Affiliation:
Department of Cardiac Surgery, Beijing Children’s Hospital affiliated to Capital Medical University, National Center for Children’s Health, Beijing, China
*
Author for correspondence: Li Xiaofeng, Department of Cardiac Surgery, Beijing Children’s Hospital Affiliated to Capital Medical University, National Center for Children’s Health, 56 South Lishi Road, Xicheng District, Beijing, Beijing, 10045, China. Tel: +86 010 59616783. E-mail: lxfbjetyy@163.com

Abstract

Objectives:

Anomalous origin of the left coronary artery from the pulmonary artery is associated with high mortality if not timely surgery. We reviewed our experience with anomalous origin of the left coronary artery from the pulmonary artery to assess the preoperative variables predictive of outcome and post-operative recovery of left ventricular function.

Methods:

A retrospective review was conducted and collected data from patients who underwent anomalous origin of the left coronary artery from the pulmonary artery repair at our institute from April 2005 to December 2019. Left ventricular function was assessed by ejection fraction and the left ventricular end-diastolic dimension index. The outcomes of reimplantation repair were analysed.

Results:

A total of 30 consecutive patients underwent anomalous origin of the left coronary artery from the pulmonary artery repair, with a median age of 14.7 months (range, 1.5–59.6 months), including 14 females (46.67%). Surgery was performed with direct coronary reimplantation in 12 patients (40%) and the coronary lengthening technique in 18 (60%). Twelve patients had concomitant mitral annuloplasty. There were two in-hospital deaths (6.67%), no patients required mechanical support, and no late deaths occurred. Follow-up echocardiograms demonstrated significant improvement between the post-operative time point and the last follow-up in ejection fraction (49.43%±19.92% vs 60.21%±8.27%, p < 0.01) and in moderate or more severe mitral regurgitation (19/30 vs 5/28, p < 0.01). The left ventricular end-diastolic dimension index decreased from 101.91 ± 23.07 to 65.06 ± 12.82 (p < 0.01).

Conclusions:

Surgical repair of anomalous origin of the left coronary artery from the pulmonary artery has good mid-term results with low mortality and reintervention rates. The coronary lengthening technique has good operability and leads to excellent cardiac recovery. The decision to concomitantly correct mitral regurgitation should be flexible and be based on the pathological changes of the mitral valve and the degree of mitral regurgitation.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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