SUCCESSFUL EXTRACORPOREAL CIRCULATORY SUPPORT AFTER AORTIC REIMPLANTATION OF ANOMALOUS LEFT CORONARY-ARTERY

The development of severe heart failure is the main cause of postopera tive mortality after the surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Two patients with ALCAPA who developed low cardiac output and could not be weaned from cardiopulmonary bypass (CPB) after aortic reimplantation of the a nomalous left coronary artery were successfully treated with a centrif ugal left ventricular assist device (LVAD) and extracorporeal membrane oxygenation (ECMO). The circulation of a 10-month-old infant with sev ere left ventricular dysfunction was supported 192 h postoperatively w ith a LVAD and a 9-year-old boy with severe right ventricular failure received ECMO support for 99 h following surgery. Both patients surviv ed and, 4 and 9 months after surgery, are asymptomatic and have normal ventricular function. If CPB (up to 3 h) is not effective in improvin g ventricular function after surgery for ALCAPA, ECMO or LVAD must be used since myocardial recovery in these patients can occur only after prolonged extracorporeal circulatory support.