Late Complications After Takeuchi Repair of Anomalous Left Coronary Artery From the Pulmonary Artery: Case Series and Review of Literature
Late Complications After Takeuchi Repair of Anomalous Left Coronary Artery From the Pulmonary Artery: Case Series and Review of Literature
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DOI：
10.1007/s00246-012-0260-5
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发表时间：
2012-10-01
影响因子：
1.6
通讯作者：
Tweddell, James S.
中科院分区：
文献类型：
--
作者：
Ginde, Salil;Earing, Michael G.;Tweddell, James S.
左冠状动脉异常起源于肺动脉（ALCAPA）是一种罕见的先天性心脏病，如果不及时治疗，会导致高死亡率。外科治疗的选择包括异常冠状动脉口的再植入术、使用心外动脉供血或Takeuchi手术。Takeuchi手术包括创建一个肺动脉瓣窗和一个肺内隧道，以阻挡主动脉到异常左冠状动脉口。Takeuchi修复术后晚期并发症的发生率未知。本研究的目的是确定采用Takeuchi手术缓解ALCAPA后的长期结局。从我们的手术数据库中共识别出9例有ALCAPA病史的患者，通过Takeuchi手术缓解。进行了病历审查。Takeuchi手术时的平均年龄为49.6个月（范围5周-14.6岁）。有一例晚期死亡，原因不明。在其余8例患者中，术后平均随访时间为15.9年（13.5-19.7年）。8例存活者均存在不同程度的肺内障区主肺动脉狭窄，其中2例中度狭窄，1例重度狭窄。3例晚期存活者（38%）发生挡板泄漏。2例患者（25%）左心室收缩功能下降，3例（38%）出现至少中度二尖瓣返流。8例晚期存活者中有3例（38%）需要再次手术，以修复二尖瓣返流、挡板泄漏和主肺动脉（MPA）狭窄。文献综述表明，Takeuchi手术后并发症发生率相似，需要再次手术。与本机构直接行ALCAPA再植术的患者相比，晚期生存率或无再次手术率无显著差异。Takeuchi手术是一种建立ALCAPA双冠状动脉修复术的方法。晚期并发症很常见，需要在有先天性心脏病成人护理经验的中心进行终身护理。
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart lesion that if left untreated, results in high mortality. Surgical treatment options include reimplantation of the anomalous coronary ostia, use of extracardiac arterial blood supply, or the Takeuchi procedure. The Takeuchi procedure involves creation of an aortopulmonary window and an intrapulmonary tunnel that baffles the aorta to the ostium of the anomalous left coronary artery. The incidence of late complications following the Takeuchi repair is unknown. The goal of our study was to determine the long-term outcome after palliation of ALCAPA using the Takeuchi Procedure. A total of 9 patients with a history of ALCAPA palliated with the Takeuchi procedure were identified from our surgical database. Chart review was performed. The mean age at time of Takeuchi procedure was 49.6 months (range 5 weeks-14.6 years). There was one late death, of unknown cause. Of the remaining 8 patients, the mean length of follow-up after surgery was 15.9 years (13.5-19.7 years). All 8 survivors had some degree of main pulmonary artery stenosis in the area of the intrapulmonary baffle, with moderate stenosis in 2 and severe stenosis in 1. Three late survivors (38 %) had a baffle leak. Two patients (25 %) had decreased left ventricular systolic function and 3 (38 %) had developed at least moderate mitral valve regurgitation. Three of the 8 late survivors (38 %) required a reoperation for repair of mitral valve regurgitation, baffle leak, and main pulmonary artery (MPA) stenosis. Review of literature demonstrated similar complication rates and need for reoperation following the Takeuchi procedure. Compared with patients after direct reimplantation for ALCAPA at our institution, there was no significant difference in late survival or freedom from reoperation. The Takeuchi procedure is a method to establish a two-coronary repair for ALCAPA. Late complications are common, necessitating lifelong care in a center experienced with caring for adults with congenital heart disease.