Resolution of pathologic Q wave, left ventricular dysfunction and mitral regurgitation after dual coronary repair of the anomalous origin of the left coronary artery from the pulmonary artery

Hsin Hui Chiu, Jou Kou Wang, Chun An Chen, Sheunn Nan Chiu, Ming Tai Lin, Hung Chi Lue, Chung I. Chang, Ing Su Chiu, Mei Hwan Wu

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac defect that usually presents as dilated cardiomyopathy in infancy. From 1984 to 2005, 13 (five males and eight females, 0.13%) out of 9,950 patients with congenital heart disease were identified as ALCAPA at our institute. Corrective surgery was performed at a median age of 9 months (range: 2 months to 5 years). Eleven patients underwent direct reimplantation of the left coronary artery (LCA) to the aorta, while two received extrapulmonary baffling. The overall survival rate was 92%. Only one patient died 5 months after reimplantation of the LCA due to acute myocardial ischaemia. Left ventricular ejection fraction (LVEF) was significantly lower in the eight (62%) patients operated during infancy than in those operated beyond 5 months (median: 35% vs. 75%). Left ventricle function was normalised in 11 patients (85%). Among the eight patients without concomitant mitral annuloplasty, mitral regurgitation (MR) improved to a mild or trivial degree in six patients and remained at the pre-operative level in two patients. Pathologic Q wave was noted in 11 patients, which eventually regressed in all except two cases. The median interval of recovery was 16 days, 6 months and 24 months for MR, LVEF and electrocardiogram (ECG) changes, respectively. In conclusion, ALCAPA is also a rare disease in Asian countries, such as Taiwan. The subsequent recovery of MR, left ventricular (LV) function and even pathologic Q wave can be expected after dual coronary repair, regardless of the age at repair.

Original languageEnglish
Pages (from-to)1277-1282
Number of pages6
JournalEuropean Journal of Pediatrics
Volume167
Issue number11
DOIs
Publication statusPublished - Nov 2008
Externally publishedYes

Keywords

  • Anomalous origin
  • Coronary artery
  • Dilated cardiomyopathy
  • Mitral regurgitation
  • Pulmonary artery
  • Q wave

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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