Revista argentina de cardiología
versión On-line ISSN 1850-3748
LUGONES, Ignacio; KREUTZER, Christian; ROMAN, María I. y SCHLICHTER, Andrés J.. Outcomes after Surgical Correction of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery. Rev. argent. cardiol. [online]. 2010, vol.78, n.5, pp. 411-416. ISSN 1850-3748.
Background The anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital heart defect that produces myocardial ischemia with left ventricular dysfunction and mitral regurgitation. The natural history of the disease has been modified by the current surgical techniques which establish a system with two coronary arteries. Objectives To evaluate our experience with the surgical correction of the anomalous origin of the left coronary artery from the pulmonary artery. Material and Methods A total of 13 patients underwent surgical repair of this condition from February 2000 to May 2008. Median age was 2.5 years; range 45 days to 21 years. Six patients were <1 year old. Before surgery, 61% of patients presented congestive heart failure, 69% had signs of myocardial infarction and 84% moderate to severe heart enlargement. Average shortening fraction was 26.07% and 46% of patients had moderate to severe mitral regurgitation. The diagnosis was confirmed by coronary angiography in 11 patients. The Takeuchi procedure was performed in one patient and 12 patients underwent direct anastomosis of the anomalous left coronary artery directly to the aorta. One patient underwent mitral valve repair. Perfusion of the anomalous coronary artery and cardioplegia were provided via the pulmonary artery in six patients. Results At present, after a mean follow-up of 74.76 months, mortality rate is 0%. None of the patients presented congestive heart failure at discharge. A reduction in cardiac size was observed in 9/11 patients. The average postoperative shortening fraction was 39.92%. A decrease in the severity of mitral regurgitation was observed in all patients with only one exception. None of the patients presented severe mitral regurgitation in the late postoperative period. Conclusions The outcomes of the surgical correction of the anomalous origin of the left main coronary artery from the pulmonary artery are excellent in all age groups, with significant improvement of myocardial function and reduction of the severity of mitral regurgitation in most patients.
Palabras clave : Congenital Heart Defects; Cardiovascular Surgery; Ventricular Function; Heart Failure; Mitral Regurgitation; Myocardial Ischemia; Mitral Valve Repair.