Preoperative diagnosis and surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery
10.3760/cma.j.issn.1673-4912.2016.07.013
- VernacularTitle:左冠状动脉起源于肺动脉的术前诊断与治疗
- Author:
Xinping MA
;
Xinwei LIU
;
Rui CHEN
- Publication Type:Journal Article
- Keywords:
Anomalous origin of the left coronary artery from the pulmonary artery;
Preoperative diagnosis;
Surgical treatment
- From:
Chinese Pediatric Emergency Medicine
2016;23(7):488-491
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the preoperative diagnosis,surgical treatment and results of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).Methods We retrospectively analyzed the clinical data of 9 patients with ALCAPA who had undergone surgical treatment in Shanxi Children's Hospital from June 2010 to March 2014.Results There were 3 males and 6 females,aged from 4 months to 4 years old and 6 months,average age (1.14 ± 1.33)years,body weight from 5.6 to 18.0 kg,average weight(8.06 ± 3.99) kg.Echocardiography and spiral CT angiography were performed in all patients,one of which underwent cardiac catheter angiography.The cases of mitral regurgitation were mild in 2 cases,mild to moderate in 5 cases,and moderate to severe in 2 cases.Electrocardiogram showed abnormal Q wave,ST segment change and T wave inversion in lead Ⅰ,AVL and V4-6 in 9 cases.The X-ray sign was significant heart enlargement(C/T ratio 0.56-0.73,mean 0.61 ± 0.05).Echocardiography indicated ALCAPA,significant enlargement of left ventricle and decreased myocardial contractility(ejection fraction less than 50％).End diastolic diameter of left ventricle were more than 35 mm in 8 cases and aneurysm formation of left ventricular apex in 1 case.One case was confirmed ALCAPA by catheter angiography.Six cases had radioactive nuclide myocardial imaging,which showed different degree of myocardial infarction.All patients underwent reimplantation of left coronary artery into the aorta,mitral valvoplasty in 7 patients.One case died for low cardiac output syndrome.Others recovered and discharged.Postoperative complications included low cardiac output syndrome in 2 cases,pneumonia in 3 cases and supraventricular tachycardia in 1 case.During a followup of 3 months to 2 years,well development,good heart function,mitral valve regurgitation and ejection fraction improved in all case.Conclusion Echocardiography has important value in diagnosis of ALCAPA,which are confirmed by spiral CT angiography and catheter angiography.Preoperative nuclide examination for determinant of survival myocardium is helpful for surgery and prognosis.Reimplantation of left coronary artery into the aorta is the most ideal surgical procedure.
