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Resolution of pathologic Q wave, left ventricular dysfunction and mitral regurgitation after dual coronary repair of the anomalous origin of the left coronary artery from the pulmonary artery

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Abstract

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac defect that usually presents as dilated cardiomyopathy in infancy. From 1984 to 2005, 13 (five males and eight females, 0.13%) out of 9,950 patients with congenital heart disease were identified as ALCAPA at our institute. Corrective surgery was performed at a median age of 9 months (range: 2 months to 5 years). Eleven patients underwent direct reimplantation of the left coronary artery (LCA) to the aorta, while two received extrapulmonary baffling. The overall survival rate was 92%. Only one patient died 5 months after reimplantation of the LCA due to acute myocardial ischaemia. Left ventricular ejection fraction (LVEF) was significantly lower in the eight (62%) patients operated during infancy than in those operated beyond 5 months (median: 35% vs. 75%). Left ventricle function was normalised in 11 patients (85%). Among the eight patients without concomitant mitral annuloplasty, mitral regurgitation (MR) improved to a mild or trivial degree in six patients and remained at the pre-operative level in two patients. Pathologic Q wave was noted in 11 patients, which eventually regressed in all except two cases. The median interval of recovery was 16 days, 6 months and 24 months for MR, LVEF and electrocardiogram (ECG) changes, respectively. In conclusion, ALCAPA is also a rare disease in Asian countries, such as Taiwan. The subsequent recovery of MR, left ventricular (LV) function and even pathologic Q wave can be expected after dual coronary repair, regardless of the age at repair.

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References

  1. Anderson WD, Wagner NB, Lee KL, White RD, Yuschak J, Behar VS, Selvester RH, Ideker RE, Wagner GS (1988) Evaluation of a QRS scoring system for estimating myocardial infarct size. VI: identification of screening criteria for non-acute myocardial infarcts. Am J Cardiol 61:729–733

    Article  PubMed  CAS  Google Scholar 

  2. Ando M, Mee RB, Duncan BW, Drummond-Webb JJ, Seshadri SG, Igor Mesia CI (2002) Creation of a dual-coronary system for anomalous origin of the left coronary artery from the pulmonary artery utilizing the trapdoor flap method. Eur J Cardiothorac Surg 22:576–581

    Article  PubMed  Google Scholar 

  3. Azakie A, Russell JL, McCrindle BW, Van Arsdell GS, Benson LN, Coles JG, Williams WG (2003) Anatomic repair of anomalous left coronary artery from the pulmonary artery by aortic reimplantation: early survival, patterns of ventricular recovery and late outcome. Ann Thorac Surg 75:1535–1541

    Article  PubMed  Google Scholar 

  4. Caspi J, Pettitt TW, Sperrazza C, Mulder T, Stopa A (2007) Reimplantation of anomalous left coronary artery from the pulmonary artery without mitral valve repair. Ann Thorac Surg 84(2):619–623

    Article  PubMed  Google Scholar 

  5. Chen CA, Chiu SN, Wu ET, Lin MT, Wang JK, Chang CI, Chiu IS, Wu MH (2006) Surgical outcome of aortopulmonary window repair in early infancy. J Formos Med Assoc 105:813–820

    Article  PubMed  Google Scholar 

  6. 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 117:332–342

    Article  PubMed  CAS  Google Scholar 

  7. Dodge-Khatami A, Mavroudis C, Backer CL (2002) Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 74:946–955

    Article  PubMed  Google Scholar 

  8. Hagan AD, Deely WJ, Sahn D, Friedman WF (1973) Echocardiographic criteria for normal newborn infants. Circulation 48:1221–1226

    PubMed  CAS  Google Scholar 

  9. Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, Gatewood RP Jr (1987) Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 75:175–183

    PubMed  CAS  Google Scholar 

  10. Huddleston CB, Balzer DT, Mendeloff EN (2001) Repair of anomalous left main coronary artery arising from the pulmonary artery in infants: long-term impact on the mitral valve. Ann Thorac Surg 71:1985–1989

    Article  PubMed  CAS  Google Scholar 

  11. 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 121:792–797

    Article  PubMed  CAS  Google Scholar 

  12. Kreutzer C, Schlichter AJ, Roman MI, Kreutzer GO (2000) Emergency ligation of anomalous left coronary artery arising from the pulmonary artery. Ann Thorac Surg 69:1591–1592

    Article  PubMed  CAS  Google Scholar 

  13. Lange R, Vogt M, Hörer J, Cleuziou J, Menzel A, Holper K, Hess J, Schreiber C (2007) Long-term results of repair of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 83(4):1463–1471

    Article  PubMed  Google Scholar 

  14. Michielon G, Di Carlo D, Brancaccio G, Guccione P, Mazzera E, Toscano A, Di Donato RM (2003) Anomalous coronary artery origin from the pulmonary artery: correlation between surgical timing and left ventricular function recovery. Ann Thorac Surg 76:581–588

    Article  PubMed  Google Scholar 

  15. Nagase K, Tamura A, Mikuriya Y, Nasu M (1998) Significance of Q-wave regression after anterior wall acute myocardial infarction. Eur Heart J 19:742–746

    Article  PubMed  CAS  Google Scholar 

  16. Schinkel AF, Bax JJ, Elhendy A, Boersma E, Vourvouri EC, Sozzi FB, Valkema R, Roelandt JR, Poldermans D (2002) Assessment of viable tissue in Q-wave regions by metabolic imaging using single-photon emission computed tomography in ischemic cardiomyopathy. Am J Cardiol 89:1171–1175

    Article  PubMed  Google Scholar 

  17. Schwartz ML, Jonas RA, 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 30:547–553

    Article  PubMed  CAS  Google Scholar 

  18. Sevilla DC, Wagner NB, Anderson WD, Ideker RE, Reimer KA, Mikat EM, Hackel DB, Selvester RH, Wagner GS (1990) Sensitivity of a set of myocardial infarction screening criteria in patients with anatomically documented single and multiple infarcts. Am J Cardiol 66:792–795

    Article  PubMed  CAS  Google Scholar 

  19. St John Sutton MG, Marier DL, Oldershaw PJ, Sacchetti R, Gibson DG (1982) Effect of age related changes in chamber size, wall thickness, and heart rate on left ventricular function in normal children. Br Heart J 48:342–351

    Article  PubMed  CAS  Google Scholar 

  20. Takeuchi S, Imamura H, Katsumoto K, Hayashi I, Katohgi T, Yozu R, Ohkura M, Inoue T (1979) New surgical method for repair of anomalous left coronary artery from pulmonary artery. J Thorac Cardiovasc Surg 78:7–11

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan

    Hsin-Hui Chiu, Jou-Kou Wang, Chun-An Chen, Sheunn-Nan Chiu, Ming-Tai Lin, Hung-Chi Lue & Mei-Hwan Wu

  2. National Center of Excellence for Clinical Trials and Research, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan

    Hsin-Hui Chiu

  3. Surgery, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan

    Chung-I Chang & Ing-Su Chiu

  4. Department of Pediatrics, National Taiwan University Hospital, No. 7, Chun-Shan South Road, Taipei, Taiwan

    Mei-Hwan Wu

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  1. Hsin-Hui Chiu
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  2. Jou-Kou Wang
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  3. Chun-An Chen
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  4. Sheunn-Nan Chiu
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  5. Ming-Tai Lin
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  6. Hung-Chi Lue
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  7. Chung-I Chang
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  8. Ing-Su Chiu
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  9. Mei-Hwan Wu
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Correspondence to Mei-Hwan Wu.

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Chiu, HH., Wang, JK., Chen, CA. et al. Resolution of pathologic Q wave, left ventricular dysfunction and mitral regurgitation after dual coronary repair of the anomalous origin of the left coronary artery from the pulmonary artery. Eur J Pediatr 167, 1277–1282 (2008). https://doi.org/10.1007/s00431-008-0667-4

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  • DOI: https://doi.org/10.1007/s00431-008-0667-4

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