Reimplantation technique for management of anomalous left coronary artery from pulmonary artery

AIM:To discuss the experience of reimplantation technique for the management of anomalous left coronary artery from the pulmonary artery (ALCAPA). METHODS: Twenty-six ALCAPA patients (14 males and 12 females aged 4 months to 6 years) underwent aortic reimplantation between April 2008 and April 2013 and were retrospectively reviewed. Preoperative diagnoses were established by transthoracic echocardiography, computed tomography and/or coronary angiography. Preoperative left ventricular ejection fraction (LVEF) was 20.0-80.0(48±18)%, cardiothoracic ratio (C/T) was 0.54-0.77(0.64±0.07), and preoperative degree of mitral regurgitation (MR) was none in five patients, mild in four, moderate in ten and severe in seven patients. One patient had left ventricular apical aneurysm and one patient had atrial septal defect (ASD). Eleven patients had concomitant mitral valve surgery. Aneurysm resection and ASD closure were additionally performed, respectively, in two patients. RESULTS: The operation was successful in all patients, with cardiopulmonary bypass time from 91 to 238(150±37) min and aortic cross-clamp time from 64 to 200 (126±36) min. No death occurred during the 1- to 61-month follow-up and the last follow-up showed that LVEF was 35-75(64±11)%, C/T was 0.48-0.65(0.57±0.05), significantly improved compared with preoperative and mitral regurgitation was below moderate in 24 patients. CONCLUSION: The implantation technique produces good results for anomalous left coronary artery from the pulmonary artery and we recommend surgical repair of moderate and severe MR at the time of ALCAPA procedure.