Surgical treatment and follow-ups of anomalous origin of the left coronary artery from the pulmonary artery in children

WANG Yan-fei; MA Li; CUI Yan-qin; CUI Hu-jun; CHEN Xin-xin

Abstract：Objective To analyze the surgical treatment and follow-up outcomes of anomalous origin of the left coronary artery from the pulmonary artery ( ALCAPA) in children.Methods 20 cases of ALCAPA were retrospectively analyzed, including 8 boys and 12 girls, aged from 2 months to 13 years.The preoperative ejection fraction ( EF) of left ventricular ranged from 8%to 65%, and 16 children presented with EF<40%.All 20 patients were operated by direct reimplantation of the left coronary artery into the ascending aorta using moderate or deep hypothermia cardiopulmonary by-pass.Surgery was undertaken on an urgent basis in 8 patients and on a semi-elective basis in the remaining 12 children. Concurrent mitral valvoplasty was performed in 6 children.Results The hospital mortality was 15%( 3/20 ) .One case was due to postoperative low cardiac output, and the other two patients died from refractory ventricular fibrillation.One pa-tient was lost to follow-up.The remaining 16 patients were asymptomatic during follow-ups of 3 to 67 months.EF was elevated from preoperative <40% to over 50% in 61.5% ( 8/13 ) patients within 3 to 6 months after surgery and in 90.9%(10/11) patients 1 year after surgery.Conclusions Implantation of the left coronary artery from the pulmonary artery into aorta is an effective surgical treatment for ALCAPA.Low cardiac output and malignant ventricular arrhythmia are two main causes of death after ALCAPA surgery.The heart function is expected to recover if the patients can carry though the perioperative period, and good outcomes can be achieved after the surgery of ALCAPA.