Repair of anomalous left main coronary artery arising from the pulmonary artery in infants: Long-term impact on the mitral valve
Repair of anomalous left main coronary artery arising from the pulmonary artery in infants: Long-term impact on the mitral valve
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DOI：
10.1016/s0003-4975(01)02518-8
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发表时间：
2001-06-01
影响因子：
4.6
通讯作者：
Mendeloff, EN
中科院分区：
文献类型：
--
作者：
Huddleston, CB;Balzer, DT;Mendeloff, EN
背景。患有左冠状动脉偏离肺动脉（ALCAPA）的婴儿通常患有心力衰竭，并且经常有明显的二尖瓣关闭不全（MR）。尽管建立双冠状动脉循环是首选手术，但对于如何处理二尖瓣仍存在争议。方法。我们回顾了在圣路易斯儿童医院处理该病变的经验。在过去的15年里，有17名18个月以下的婴儿接受了修复手术，除了一名婴儿外，所有婴儿都接受了将左冠状动脉重新植入主动脉的治疗；另一名患者接受了 Takeuchi 手术（肺内动脉挡板），并被排除在本次评估之外。手术时的平均年龄和体重分别为 0.5 +/- 0.3 岁和 6.1 +/- 1.9 kg。所有患者均出现不同程度的心力衰竭，其中 9 名患者还出现中度或重度 MR.结果。左冠状动脉再植入后有 1 例早期死亡，无晚期死亡。修复后左心室功能从术前缩短分数 0.19 +/- 0.09 改善至 0.34 +/- 0.08 (p < 0.01)。 2 例患者术后出现中度或重度 MR，且术后均出现左冠状动脉明显阻塞。两人均接受了二尖瓣修复和左冠状动脉血运重建。结论。治疗这一高危人群可以获得极好的结果。初次手术时通常不需要修复二尖瓣。然而，如果 MR 复发或持续较晚，则可能预示着同时存在显着的冠状动脉狭窄。在进行二尖瓣手术之前，应进行心导管检查以评估左冠状动脉的通畅性。 (C) 2001 年，胸外科医师协会。
Background. Infants presenting with anomalous left coronary artery off the pulmonary artery (ALCAPA) are generally in heart failure and often have significant mitral valve regurgitation (MR). Although establishing a dual coronary circulation is the procedure of choice, there remains controversy as to how the mitral valve is handled.Methods. We reviewed our experience with this lesion at St. Louis Children's Hospital. Over the past 15 years, 17 infants under 18 months of age have undergone repair, with all but one being treated with reimplantation of the left coronary artery into the aorta; the other underwent the Takeuchi procedure (intrapulmonary artery baffle) and was excluded from this evaluation. The average age and weight at operation were 0.5 +/- 0.3 years and 6.1 +/- 1.9 kg, respectively. All presented with varying degrees of heart failure and 9 patients also had either moderate or severe MR.Results. There was one early and no late deaths after reimplantation of the left coronary artery. The left ventricular function postrepair improved from a preoperative shortening fraction of 0.19 +/- 0.09 to 0.34 +/- 0.08 (p < 0.01). Moderate or severe MR was present in 2 patients postoperatively, and both developed significant obstruction in the left coronary artery postoperatively as well. Both underwent mitral valve repair and revascularization of the left coronary artery.Conclusions. Excellent results can be obtained in the treatment of this very high-risk group of patients. Mitral valve repair is not generally necessary at the time of the initial operation. However, should MR recur or persist late, it may herald the presence of a coexistent, significant coronary stenosis. Cardiac catheterization should be performed to assess the patency of the left coronary artery before performing mit al valve surgery. (C) 2001 by The Society of Thoracic Surgeons.