Repair of Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA) beyond Infancy

Authors

  • Sachin Talwar
  • Aandrei Jivendra Jha
  • Shiv Kumar Choudhary
  • Saurabh Kumar Gupta
  • Balram Airan

DOI:

https://doi.org/10.1532/HSF98.20131008

Abstract

Between January 2002 and December 2012, five patients (4 female) underwent corrective surgery for anomalous left coronary artery from pulmonary artery (ALCAPA). They were older than 1 year (range, 3-56 years). One of the 2 patients younger than 10 years had presented with congestive heart failure, and the other had experienced repeated episodes of lower respiratory tract infection since childhood. Of the remaining 3 adult patients, 2 had experienced angina with effort, and 1 patient had had repeated respiratory tract infections since childhood, with mild dyspnea on effort of New York Heart Association (NYHA) class II. Three patients had the anomalous left coronary artery implanted directly into the ascending aorta via coronary-button transfer, and 2 patients underwent coronary artery bypass with obliteration of the left main ostium. Two patients underwent concomitant mitral valve repair procedures, and 1 patient underwent direct closure of a perimembranous ventricular septal defect. Four patients survived the surgery, and 1 patient died because of a persistently low cardiac output. Follow-up times ranged from 3 months to 4 years. All survivors are in NYHA class I and have left ventricular ejection fractions of 45% to 60%, with moderate (n = 1), mild (n = 1), or no (n = 2) mitral insufficiency. We conclude that a few naturally selected patients with ALCAPA do survive beyond infancy and can undergo establishment of 2 coronary systems with satisfactory results.

References

Abbot ME. 1908. Congenital heart disease. In: Osler W, ed. Modern medicine: its theory and practice. Philadelphia, PA: Lea and Febiger. p 420-1.nAkbari J, Theodore S, Krishnamanohar SR, Neelakandhan KS. 2007. Pulmonary hypertension alters natural history of anomalous left coronary artery. Asian Cardiovasc Thorac Ann 15:23-4.nAli WB, Metton O, Roubertie F, et al. 2009. Anomalous origin of the left coronary artery from the pulmonary artery: late results with special attention to the mitral valve. Eur J Cardiothorac Surg 36:244-9.nBergmann O, Bhardwaj RD, Bernard S, et al. 2009. Evidence for cardiomyocyte renewal in humans. Science 324:98-102.nBland EF, White PD, Garland J. 1933. Congenital anomalies of the coronary arteries. Report of an unusual case associated with cardiac hypertrophy. Am Heart J 8:787-801.nBrown JW, Ruzmetov M, Parent JJ, Rodefeld MD, Turrentine MW. 2008. Does the degree of preoperative mitral regurgitation predict survival or the need for mitral valve repair or replacement in patients with anomalous origin of the left coronary artery from the pulmonary artery? J Thorac Cardiovasc Surg 136:743-8.nCollins N, Colman J, Benson L, Hansen M, Merchant N, Horlick E. 2007. Successful percutaneous treatment of anomalous left coronary artery from pulmonary artery. Int J Cardiol 122:e29-31.nCooley DA, Hallman GL, RD Bloodwell. 1966. Definitive surgical treatment of anomalous origin of the left coronary artery from pulmonary artery: indications and results. J Thorac Cardiovasc Surg 52:798-808.nDodge-Khatami A, Mavroudis C, Backer CL. 2002. Anomalous origin of left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 74:946-55.nFierens C, Budts W, Denef B, Van De Werf F. 2000. A 72 year old woman with ALCAPA. Heart 83:e2.nIsomatsu Y, Imai Y, Shin;oka T, Aoki M, Iwata Y. 2001. Surgical intervention for anomalous origin of the left coronary artery from the pulmonary artery: the Tokyo experience. J Thorac Cardiovasc Surg 121:792-7.nLim JY, Chung CH, Ma DS, Lee SH. 2011. A 69-year-old woman with anomalous origin of left coronary artery from the pulmonary artery: surgical repair using a trap-door flap. Korean J Thorac Cardiovasc Surg 44:358-60.nMoodie DS, Fyfe D, Gill, et al. 1983. Anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome) in adult patients: long-term follow-up after surgery. Am Heart J 106:381-8.nNeches WH, Mathews RA, Park SC, et al. 1974. Anomalous origin of the left coronary artery from the pulmonary artery. A new method of surgical repair. Circulation 50:582-7.nRaghuram AR, Krishnan R, Kumar S. 2004. Anomalous left coronary artery from pulmonary artery in an adult. Ind J Thorac Cardiovasc Surg.20: 213-15.nSabiston DC Jr, Neil CA, Taussig HB. 1960. The direction of blood flow in anomalous left coronary artery arising from the pulmonary artery. Circulation 22:591-7.nSchwartz ML, Jonas RA, Colan SD. 1997. Anomalous origin of the left coronary artery from the pulmonary artery: recovery of left ventricular function after dual coronary repair. J Am Coll Cardiol 30:547-53.nShivalker B, Borgers M, Daenen W, Gewillig M, Flameng W. 1994. ALCAPA syndrome: an example of chronic myocardial hypoperfusion? J Am Coll Cardiol 23:772-8.nTakeuchi S, Imamura S, Katsumoto K, et al. 1979. New surgical method for repair of anomalous left coronary artery from pulmonary artery. J Thorac Cardiovasc Surg 78:7-11.nWesselhoeft H, Fawcett JS, Johnson AL. 1968. Anomalous origin of the left coronary artery from the pulmonary trunk. Its clinical spectrum, pathology, and pathophysiology, based on a review of 140 cases with seven further cases. Circulation 38:403-25.nYau JM, Singh R, Halpern EJ. Fischman D. 2011. Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman. Clin Cardiol 34;4:204-10.n

Published

2013-08-19

How to Cite

Talwar, S., Jha, A. J., Choudhary, S. K., Gupta, S. K., & Airan, B. (2013). Repair of Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA) beyond Infancy. The Heart Surgery Forum, 16(4), E210-E215. https://doi.org/10.1532/HSF98.20131008

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