Advertisement

Pediatric Cardiology

, Volume 33, Issue 7, pp 1115–1123 | Cite as

Late Complications After Takeuchi Repair of Anomalous Left Coronary Artery From the Pulmonary Artery: Case Series and Review of Literature

  • Salil GindeEmail author
  • Michael G. Earing
  • Peter J. Bartz
  • Joseph R. Cava
  • James S. Tweddell
Original Article

Abstract

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart lesion that if left untreated, results in high mortality. Surgical treatment options include reimplantation of the anomalous coronary ostia, use of extracardiac arterial blood supply, or the Takeuchi procedure. The Takeuchi procedure involves creation of an aortopulmonary window and an intrapulmonary tunnel that baffles the aorta to the ostium of the anomalous left coronary artery. The incidence of late complications following the Takeuchi repair is unknown. The goal of our study was to determine the long-term outcome after palliation of ALCAPA using the Takeuchi Procedure. A total of 9 patients with a history of ALCAPA palliated with the Takeuchi procedure were identified from our surgical database. Chart review was performed. The mean age at time of Takeuchi procedure was 49.6 months (range 5 weeks–14.6 years). There was one late death, of unknown cause. Of the remaining 8 patients, the mean length of follow-up after surgery was 15.9 years (13.5–19.7 years). All 8 survivors had some degree of main pulmonary artery stenosis in the area of the intrapulmonary baffle, with moderate stenosis in 2 and severe stenosis in 1. Three late survivors (38 %) had a baffle leak. Two patients (25 %) had decreased left ventricular systolic function and 3 (38 %) had developed at least moderate mitral valve regurgitation. Three of the 8 late survivors (38 %) required a reoperation for repair of mitral valve regurgitation, baffle leak, and main pulmonary artery (MPA) stenosis. Review of literature demonstrated similar complication rates and need for reoperation following the Takeuchi procedure. Compared with patients after direct reimplantation for ALCAPA at our institution, there was no significant difference in late survival or freedom from reoperation. The Takeuchi procedure is a method to establish a two-coronary repair for ALCAPA. Late complications are common, necessitating lifelong care in a center experienced with caring for adults with congenital heart disease.

Keywords

Coronary artery anomalies ALCAPA Takeuchi Intrapulmonary tunnel procedure 

References

  1. 1.
    Arciniegas E, Farooki ZQ, Hakimi M, Green EW (1980) Management of anomalous left coronary artery from the pulmonary artery. Circulation 62:I180–I189PubMedGoogle Scholar
  2. 2.
    Askenazi J, Nadas AS (1975) Anomalous left coronary artery originating from the pulmonary artery: report on 15 cases. Circulation 51:976–987PubMedCrossRefGoogle Scholar
  3. 3.
    Ben Ali W, 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 36:244–248PubMedCrossRefGoogle Scholar
  4. 4.
    Birk E, Stamler A, Katz J et al (2000) Anomalous origin of the left coronary artery from the pulmonary artery: diagnosis and postoperative follow up. Isr Med Assoc J 2:111–114PubMedGoogle Scholar
  5. 5.
    Bland EF, White PD, Garland J (1933) Congenital anomalies of the coronary arteries: report of an unusual case associated with cardiac hypertrophy. Am Heart J 8:787–801CrossRefGoogle Scholar
  6. 6.
    Brooks SJ (1886) Two cases of abnormal coronary artery of the heart arising from the pulmonary artery: with some remarks upon the effect of this anomaly in producing cirsoid dilation of the vessels. J Anat Physiol 20:26–32Google Scholar
  7. 7.
    Bunton R, Jonas RA, Lang P, Rein AJ, Castaneda AR (1987) Anomalous origin of the left coronary artery from pulmonary artery. Ligation versus establishment of a two-coronary system. J Thorac Cardiovasc Surg 93:103–108PubMedGoogle Scholar
  8. 8.
    Cochrane AD, Coleman DM, Davis AM, Brizard CP, Wolfe R, Karl TR (1999) Excellent long-term functional outcome after an operation for anomalous left coronary artery from the pulmonary artery. J Thorac Cardiovasc Surg 117:332–342PubMedCrossRefGoogle Scholar
  9. 9.
    Dodge-Khatami A, Mavroudis C, Backer C (2002) Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 74:946–955PubMedCrossRefGoogle Scholar
  10. 10.
    Edwards JE (1964) The direction of blood flow in coronary arteries arising from the pulmonary trunk. Circulation 29:163–166PubMedCrossRefGoogle Scholar
  11. 11.
    Fehrenbacher TA, Mitchell ME, Ghanayem NS, Tweddell JS (2010) Surgery and critical care for anomalous coronary artery from the pulmonary artery. Cardiol Young 20(Suppl 3):35–43PubMedCrossRefGoogle Scholar
  12. 12.
    Hamilton DI, Ghosh PK, Donnelly RJ (1979) An operation for anomalous origin of left coronary artery. Br Heart J 41:121–124PubMedCrossRefGoogle Scholar
  13. 13.
    Huddleston CB, Balzer D, Mendeloff E (2001) Repair of anomalous left main coronary artery arising from the pulmonary artery in infants: long-term impact of the mitral valve. Ann Thorac Surg 71:1985–1989PubMedCrossRefGoogle Scholar
  14. 14.
    Isomatsu 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 121:792–797PubMedCrossRefGoogle Scholar
  15. 15.
    Lange R, Vogt M, Horer J et al (2007) Long-term results of repair of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 83:1463–1471PubMedCrossRefGoogle Scholar
  16. 16.
    Neches 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 50:582–587PubMedCrossRefGoogle Scholar
  17. 17.
    Schwartz ML, Jonas R, Colan SD (1997) Anomalous origin of left coronary artery from pulmonary artery: recovery of left ventricular function after dual coronary repair. J Am Coll Cardiol 30:547–553PubMedCrossRefGoogle Scholar
  18. 18.
    Takeuchi S, Imamura H, Katsumoto K et al (1979) New surgical method for repair of anomalous left coronary artery from pulmonary artery. J Thorac Cardiovasc Surg 78:7–11PubMedGoogle Scholar
  19. 19.
    Talwar S, Bhan A, Sharma R et al (2000) Two-coronary repair for anomalous left coronary artery from pulmonary artery. Asian Cardiovasc Thorac Ann 8:27–31CrossRefGoogle Scholar
  20. 20.
    Wesselhoeft 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 review of 140 cases with seven further cases. Circulation 38:403–425PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Salil Ginde
    • 1
    Email author
  • Michael G. Earing
    • 1
    • 2
  • Peter J. Bartz
    • 1
    • 2
  • Joseph R. Cava
    • 1
  • James S. Tweddell
    • 3
  1. 1.Division of Pediatric Cardiology, Department of PediatricsMedical College of WisconsinMilwaukeeUSA
  2. 2.Division of Cardiovascular Medicine, Department of Internal MedicineMedical College of WisconsinMilwaukeeUSA
  3. 3.Department of Cardiothoracic SurgeryMedical College of WisconsinMilwaukeeUSA

Personalised recommendations