HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Guido Michielon Duccio Di Carlo Gianluca Brancaccio Ennio Mazzera Roberto Michele Di Donato Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Michielon, G. Articles by Di Donato, R. M. Search for Related Content PubMed PubMed Citation Articles by Michielon, G. Articles by Di Donato, R. M. Related Collections Congenital - acyanotic

Ann Thorac Surg 2003;76:581-588
© 2003 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Anomalous coronary artery origin from the pulmonary artery: correlation between surgical timing and left ventricular function recovery

^a Department of Medico-Chirurgico di Cardiochirurgia e, DMCCP, Ospedale Pediatrico Bambino Gesù, Roma, Italy
^b Department of Cardiologia Pediatrica, DMCCP, Ospedale Pediatrico Bambino Gesù, Rome, Italy

Accepted for publication February 13, 2003.

^* Address reprint requests to Dr Michielon, Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy
e-mail: guido.michielon{at}tin.it

BACKGROUND: This study investigates the correlation between surgical timing and 15-year longitudinal left ventricular and mitral valve function, after repair of anomalous coronary artery origin from the pulmonary artery.

METHODS: Between 1987 and 2002, 31 patients (median age, 7.1 months) underwent repair for anomalous origin of the left (n = 28), right (n = 2), or both (n = 1) coronary arteries from the pulmonary artery. Repair was accomplished by subclavian interposition in 5 patients, intrapulmonary tunnel in 12, and direct aortic reimplantation in 14. Primary mitral valve repair was never associated with coronary revascularization. Total follow-up was 186.4 patient-years (mean, 77.2 months).

RESULTS: Fifteen-year actuarial survival was 92.9% ± 4.9% for coronary transfer, 40.0% ± 21.9% for subclavian interposition, and 89.9% ± 7.5% for intrapulmonary tunnel (p = 0.019). Five patients required further intervention for supravalvular pulmonary stenosis (n = 3), baffle leak (n = 1), and mitral valve replacement (n = 1). Coronary transfer allowed best freedom from long-term reoperation (92.3% ± 7.4%). Left ventricular shortening fraction increased from 17.3% ± 6.3% before operation to 34.1% ± 4.6% at last follow-up (p < 0.01). Regression analysis demonstrated a linear relationship between age at repair and shortening fraction recovery (r² = 0.573, p < 0.01). Patients younger than 6 months of age showed worse preoperative shortening fraction (15.9% ± 5.2%) and best longitudinal shortening fraction recovery (36.4% ± 5.1%; p < 0.001). Major improvement in mitral valve function was observed within 1 year from surgery in 90.4% of survivors.

CONCLUSIONS: Repair of anomalous coronary artery origin from the pulmonary artery in younger symptomatic infants offers the best potential for recovery of left ventricular function, despite a worse initial presentation. Coronary transfer is associated with superior long-term survival and freedom from reoperation. Most patients with patent two-coronary repair will recover normal mitral valve function; therefore, simultaneous mitral valve surgery seems unwarranted.

This article has been cited by other articles:

				O. Raisky, F. Roubertie, W. B. Ali, and P. R. Vouhe Anomalous origin of the left coronary artery from the pulmonary artery: surgical treatment MMCTS, May 23, 2008; 2008(0523): 3285. [Abstract] [Full Text] [PDF]

				Q. Wu and Z. Xu An Alternative Procedure for Correction of Anomalous Origin of Left Coronary Artery From the Pulmonary Artery Ann. Thorac. Surg., December 1, 2007; 84(6): 2132 - 2133. [Abstract] [Full Text] [PDF]

				J. Caspi, T. W. Pettitt, C. Sperrazza, T. Mulder, and A. Stopa Reimplantation of Anomalous Left Coronary Artery From the Pulmonary Artery Without Mitral Valve Repair Ann. Thorac. Surg., August 1, 2007; 84(2): 619 - 623. [Abstract] [Full Text] [PDF]

				M. Yamagishi, K. Shuntoh, T. Shinkawa, T. Hisaoka, M. Ogawa, K. Kohshi, H. Yaku, Y. Kajiyama, and K. Hamaoka Partial left ventriculectomy for infantile ischemic cardiomyopathy caused by anomalous origin of the left coronary artery from the pulmonary artery J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 897 - 899. [Full Text] [PDF]

				S. Rathinam, O. Stumper, W. J. Brawn, and D. J. Barron Cleft Mitral Valve in Association With Anomalous Left Coronary Artery Arising From Pulmonary Artery Ann. Thorac. Surg., September 1, 2005; 80(3): 1111 - 1113. [Abstract] [Full Text] [PDF]