Article Sidebar
Views PDF: 2
Long-term results and evolution of mitral regurgitation after surgical treatment for Anomalous Left Coronary Artery from Pulmonary Artery at Ho Chi Minh City Heart Institute
Main Article Content
Abstract
Background:
Mitral regurgitation in anomalous left coronary artery from the pulmonary artery (ALCAPA) is secondary and caused by ischemia of papillary muscle. The study aimed to evaluate the long-term results of surgery and the evolution of mitral valve regurgitation after repair.
Methods
Retrospective review of all patients who underwent operation for ALCAPA with or without mitral repair at Ho Chi Minh City Heart Institute during the period 2000-2021.
Result
A total of 56 patients (male, 23; median age 1,67 y.o) were divided into two groups: infant ≤ 12 months (n= 25) and adults type(n=31 patients). Surgical reimplantation of the left coronary artery accounts for 43 cases for both groups. In group 2, Takeuchi’s procedure was 3 cases and left coronary bypass in 6 cases. In both groups, 33 cases required mitral valve repair, 4 cases required replacement and 19 cases did not required intervention the mitral valve. There were 3 operative deaths (all in group 1) and no late deaths. The mean follow-up time after surgery was 92.5 ± 56.6 months. Only one patient lost to follow-up.The 52 survivors all had LVEFs above 55-60%. Overall cumulative survival at 5, 10, and 20 years was 94.6 ± 3%. 6/33 cases with initial valve repair had to have re-operation due to recurrent valve regurgitation (3 months-19 years after the initial surgery). At the time of final follow-up, 30 patients have mild to moderate mitral regurgitation. 19 patients without mitral intervention did not significantly change the degree of mitral regurgitation. Freedom from all causes of re-operation at 5 and 15 years was 94.4 ± 4% and 82.6 ± 8.6%. Freedom from re-operation for evolutive mitral regurgitation at 15 years was 84.8 ± 1.06% (group 1) and 81.8 ±1.16% (group 2), P= 0,045.
Conclusion
Surgical treatment for ALCAPA gives good long-term results. Evolutive mitral regurgitation after mitral surgery is more common in adults than in the infant group and requires continued periodic monitoring in follow-up.
Article Details
Keywords
ALCAPA, mitral regurgitation, reimplantation of the left coronary artery, redo
References
2. 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: 582–587. doi: 10.1161/01.CIR.50.3.582.
3. Mishra A. Surgical management of anomalous origin of the coronary artery from pulmonary artery. Indian J Thorac Cardiovasc Surg 2021; 37 (Suppl 1): S131–S143.
4. Hu R, Zhang W, Yu X, Zhu H, Zhang H, Liu J. Midterm Surgical Outcomes for ALCAPA Repair in Infants and Children. Thorac Cardiovasc Surg 2022; 70: 2–9.
5. Furuta A, Matsumura G, Shikawa T, Niinami H. Long‐term surgical results of anomalous origin of the left coronary artery from the pulmonary artery repair in infants and older patients. J Card Surg. 2021; 36: 821–827.
6. Ismail M, Jijet A, Alhuwaymil RM, Alahmari R, Alshahrani R, Almutairi R, et al. Long-Term Outcome of the Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery (ALCAPA) in Children After Cardiac Surgery: A Single-Center Experience. Cureus 2020; 12(12): e11829. doi:10.7759/cureus.11829.
7. Triglia LT, Guariento A, Zanotto L, Zanotto L, Cattapan C, Hu R et al. Anomalous left coronary artery from pulmonary artery repair: Outcomes from the European Congenital Heart Surgeons Association Database. J Card Surg 2021; 36:1910–1916.
8. Brown JW, Ruzmetov M, Parent JJ, Rodefeld MD, Turrentine MW. Does the degree of preoperative mitral regurgitation predict survival or the need for mitral valve repair or replacement in patients with anomalous origin of the left coronary artery from the pulmonary artery? J Thorac Cardiovasc Surg 2008;136: 743–8.
9. Isomatsu Y, Imai Y, Shin’oka T, Aoki M, Iwata Y, Surgical intervention for anomalous origin of the left coronary artery from the pulmonary artery: the Tokyo experience. J Thorac Cardiovasc Surg 2001;121: 792–7.
10. Kudumula V, Mehta C, Stumper O, Desai T, Chikermane A, Miller P et al. Twenty-year outcome of anomalous origin of left coronary artery from pulmonary artery: management of mitral regurgitation. Ann Thorac Surg 2014;97: 938–44.
11. Ben Ali W, Metton O, Roubertie F, Pouard P, Sidi D, Raisky O et al. Anomalous origin of the left coronary artery from the pulmonary artery: late results with special attention to the mitral valve. Eur J Cardiothorac Surg 2009;36: 244–8.
12. Yu J, Ren Q, Liu X, Chen T, Liufu R, Wen S et al. Anomalous left coronary artery from the pulmonary artery: Outcomes and management of mitral valve. Front Cardiovasc Med 2022; 9:953420.
13. Sasikumar D, Dharanb BS, Arunakumara P, Gopalakrishnana A, Sivasankarana S and Krishnamoorthya KM. The outcome of mitral regurgitation after the repair of anomalous left coronary artery from the pulmonary artery in infants and older children. Interact CardioVasc Thorac Surg 2018; 27: 238–242.
14. Naimo PS, Fricke TA, d’Udekem Y, Cochrane AD, Bullock A, Robertson T, et al. Surgical Intervention for Anomalous Origin of Left Coronary Artery From the Pulmonary Artery in Children: A Long-Term Follow-Up. Ann Thorac Surg 2016; 101(5):1842-8.