DOI QR코드

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An Alternative Surgical Technique for Repair of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

  • Kim, Young-Su (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Mina (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Yang Hyun (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang, Ji-Hyuk (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jun, Tae-Gook (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2013.09.02
  • 심사 : 2013.10.25
  • 발행 : 2014.06.05

초록

Background: For the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA. Methods: Between October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed. Results: There was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement. Conclusion: Our modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA.

키워드

참고문헌

  1. Brooks HS. Two cases of an abnormal coronary artery of the heart arising from the pulmonary artery: with some remarks upon the effect of this anomaly in producing cirsoid dilatation of the vessels. J Anat Physiol 1885;20(Pt 1):26-9.
  2. Backer CL, Stout MJ, Zales VR, et al. Anomalous origin of the left coronary artery: a twenty-year review of surgical management. J Thorac Cardiovasc Surg 1992;103:1049-57.
  3. Kreutzer C, Schlichter AJ, Roman MI, Kreutzer GO. Emergency ligation of anomalous left coronary artery arising from the pulmonary artery. Ann Thorac Surg 2000;69: 1591-2. https://doi.org/10.1016/S0003-4975(00)01179-6
  4. Wesselhoeft H, Fawcett JS, Johnson AL. 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 1968;38:403-25. https://doi.org/10.1161/01.CIR.38.2.403
  5. Edwards JE. The direction of blood flow in coronary arteries arising from the pulmonary trunk. Circulation 1964;29:163-6. https://doi.org/10.1161/01.CIR.29.2.163
  6. Jin Z, Berger F, Uhlemann F, Schroder C, et al. Improvement in left ventricular dysfunction after aortic reimplantation in 11 consecutive paediatric patients with anomalous origin of the left coronary artery from the pulmonary artery: early results of a serial echocardiographic follow-up. Eur Heart J 1994;15:1044-9. https://doi.org/10.1093/oxfordjournals.eurheartj.a060626
  7. Alexi-Meskishvili V, Hetzer R, Weng Y, et al. Anomalous origin of the left coronary artery from the pulmonary artery: early results with direct aortic reimplantation. J Thorac Cardiovasc Surg 1994;108:354-62.
  8. Neches WH, Mathews RA, Park SC, et al. Anomalous origin of the left coronary artery from the pulmonary artery: a new method of surgical repair. Circulation 1974;50:582-7. https://doi.org/10.1161/01.CIR.50.3.582
  9. Vouhe PR, Tamisier D, Sidi D, et al. Anomalous left coronary artery from the pulmonary artery: results of isolated aortic reimplantation. Ann Thorac Surg 1992;54:621-6. https://doi.org/10.1016/0003-4975(92)91004-S
  10. Turley K, Szarnicki RJ, Flachsbart KD, Richter RC, Popper RW, Tarnoff H. Aortic implantation is possible in all cases of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 1995;60:84-9. https://doi.org/10.1016/S0003-4975(95)00355-X
  11. Pena E, Nguyen ET, Merchant N, Dennie G. ALCAPA syndrome: not just a pediatric disease. Radiographics 2009;29: 553-65. https://doi.org/10.1148/rg.292085059
  12. Dodge-Khatami A, Mavroudis C, Backer CL. Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 2002;74:946-55. https://doi.org/10.1016/S0003-4975(02)03633-0
  13. Alsoufi B, Sallehuddin A, Bulbul Z, et al. Surgical strategy to establish a dual-coronary system for the management of anomalous left coronary artery origin from the pulmonary artery. Ann Thorac Surg 2008;86:170-6. https://doi.org/10.1016/j.athoracsur.2008.03.032
  14. El-Rassi I, Soueide A, Sweid O, Chabb B. Transfer technique of an anomalous coronary artery from the anterior pulmonary artery. Ann Thorac Surg 2012;93:1738-40. https://doi.org/10.1016/j.athoracsur.2011.12.046
  15. Barth MJ, Allen BS, Gulecyuz M, Chiemmongkoltip P, Cuneo B, Ilbawi MN. Experience with an alternative technique for the management of anomalous left coronary artery from the pulmonary artery. Ann Thorac Surg 2003;76: 1429-34. https://doi.org/10.1016/S0003-4975(03)00897-X
  16. Kang CH, Kim WH, Seo HJ, et al. Surgical treatment of anomalous origin of coronary artery from the pulmonary artery: postoperative changes of ventricular dimensions and mitral regurgitation. Korean J Thorac Cardiovasc Surg 2004;37:19-26.
  17. Azakie A, Russell JL, McCrindle BW, et al. 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 2003;75:1535-41. https://doi.org/10.1016/S0003-4975(02)04822-1
  18. Caspi J, Pettitt TW, Sperrazza C, Mulder T, Stopa A. Reimplantation of anomalous left coronary artery from the pulmonary artery without mitral valve repair. Ann Thorac Surg 2007;84:619-23. https://doi.org/10.1016/j.athoracsur.2007.03.036

피인용 문헌

  1. Surgical management of anomalous origin of coronary artery from pulmonary artery vol.37, pp.suppl1, 2014, https://doi.org/10.1007/s12055-021-01147-8