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The Annals of Thoracic Surgery, Vol 54, 621-626, Copyright © 1992 by The Society of Thoracic Surgeons
PR Vouhe, D Tamisier, D Sidi, F Vernant, P Mauriat, P Pouard and F Leca
Thirty-one consecutive children with anomalous left coronary artery
underwent direct aortic reimplantation of the anomalous artery without an
associated procedure. There were five deaths (16%; 70% confidence limits,
9% to 26%), three in the hospital and two early (within 3 months). The
severity of preoperative left ventricular dysfunction was the only
incremental risk factor for mortality: 31% mortality rate among patients
with left ventricular shortening fraction of less than 0.20 versus 0% among
patients with a left ventricular shortening fraction of 0.20 or more (p =
0.03). There were no late deaths up to 6 years, a survival rate of 84% +/-
7%. Late results were studied in 23 survivors having a follow-up of longer
than 12 months. Ninety-six percent were free of symptoms; left ventricular
function recovered to normal in all patients; moderate to severe mitral
regurgitation decreased to minimal or no regurgitation in most patients
(5/7); and the reimplanted anomalous left coronary artery was patent in
each patient. Based on this study, we reached five conclusions. (1) Direct
aortic reimplantation is technically feasible in most patients with
anomalous left coronary artery and yields a high rate of late patency. (2)
Left ventricular resection is unnecessary. (3) The mitral valve should not
be interfered with at the initial operation, but mitral regurgitation may
persist in a few patients and necessitate later operation. (4) In patients
with moderate left ventricular dysfunction, the operative risk is low and
early operation indicated. (5) In patients with severe left ventricular
dysfunction, the operative risk is high; heart transplantation may be
suggested, but our current approach favors an immediate corrective
procedure.
ARTICLES
Anomalous left coronary artery from the pulmonary artery: results of isolated aortic reimplantation
Department of Cardiovascular Surgery, Laennec Hospital, Paris, Frnce.
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