Outcomes of Anomalous Left Coronary Artery From Pulmonary Artery Repair: Beyond Normal Function
Outcomes of Anomalous Left Coronary Artery From Pulmonary Artery Repair: Beyond Normal Function
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DOI：
10.1016/j.athoracsur.2014.12.035
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发表时间：
2015-03-27
影响因子：
4.6
通讯作者：
Fraser, Charles D., Jr.
中科院分区：
文献类型：
--
作者：
Cabrera, Antonio G.;Chen, Diane W.;Fraser, Charles D., Jr.
背景异常左冠状动脉从肺动脉（ALCAPA）是与高死亡率，如果左不纠正。我们描述了手术修复后的长期结果和长期随访的心室功能变化。完成了对1996年1月至2011年12月接受ALCAPA修复术的患者的回顾性审查。通过短轴缩短分数和射血分数、左心室舒张末期内径和二尖瓣返流的严重程度评估心室功能。斑点追踪超声心动图可作为早期心肌功能障碍的标志。总共有34例患者在中位年龄5个月（范围：3天至39岁）时接受了ALCAPA修复术。手术干预包括31例患者（91%）的冠状动脉移位，2例（6%）的Takeuchi修复术和1例患者（3%）的冠状动脉结扎术。5例患者（15%）同时进行二尖瓣修复术。术后无患者需要机械循环支持。无早期死亡。中位随访时间为6年（范围：1个月至14年），有5例再次手术：2例心脏移植（6%）、1例二尖瓣置换术（3%）、1例冠状动脉旁路移植术（3%）和1例室间隔缺损封堵术（3%）;术后2年有1例死亡。射血分数从21% +/- 6%改善至60% +/- 7%（p = 0.008），平均缩短分数从25% +/- 14%至38% +/- 5%（p = 0.01），平均左心室舒张末期尺寸Z评分从6.0 ± 3.8至0.9 ± 0.7（p < 0.001），中度-重度二尖瓣返流患者数量从44%（15/34）降至5%（1/21）。所有患者在末次随访时射血分数和短轴缩短分数均正常。斑点追踪超声心动图显示14例患者中有11例（79%）的整体纵向（p = 0.01）和周向应变（p = 0.03）降低。在没有机械循环支持的情况下，ALCAPA修复术的结局非常好，再介入率也很低。正常射血分数和短轴缩短分数不能准确反映这些患者的心肌功能障碍。(C)2015年美国胸外科医师协会
Background. Anomalous left coronary artery from pulmonary artery (ALCAPA) is associated with high mortality if left uncorrected. We describe long-term outcomes after surgical repair and ventricular function changes on long-term follow-up.Methods. A retrospective review of patients who had ALCAPA repair from January 1996 to December 2011 was completed. Ventricular function was assessed by shortening fraction and ejection fraction, left ventricular end-diastolic dimension, and severity of mitral regurgitation. Speckle tracking echocardiography served as a marker of early myocardial dysfunction.Results. In total, 34 patients underwent ALCAPA repair at median age of 5 months (range, 3 days to 39 years). Surgical interventions included coronary translocation in 31 patients (91%), Takeuchi repair in 2 (6%), and coronary ligation in 1 patient (3%). Concomitant mitral valve repair was performed in 5 patients (15%). No patient required mechanical circulatory support postoperatively. There was no early mortality. At median follow-up of 6 years (range, 1 month to 14 years), there were 5 reoperations: 2 heart transplants (6%), 1 mitral valve replacement (3%), 1 coronary artery bypass graft (3%), and 1 ventricular septal defect closure (3%); there was 1 death 2 years after surgery. Ejection fraction improved from 21% +/- 6% to 60% +/- 7% (p = 0.008), mean shortening fraction from 25% +/- 14% to 38% +/- 5% (p = 0.01), mean left ventricular end-diastolic dimension Z-score from 6.0 +/- 3.8 to 0.9 +/- 0.7 (p < 0.001), and number of patients with moderate-severe mitral regurgitation from 44% (15 of 34) to 5% (1 of 21). All patients had normal ejection fraction and shortening fraction at last follow-up. Speckle tracking echocardiography showed decreased global longitudinal (p = 0.01) and circumferential strain (p = 0.03) for 11 of 14 patients (79%).Conclusions. Excellent outcomes are achieved with repair of ALCAPA without mechanical circulatory support and with low reintervention rates. Normal ejection fraction and shortening fraction do not accurately convey myocardial dysfunction in these patients. (C) 2015 by The Society of Thoracic Surgeons