ANOMALOUS ORIGIN OF LEFT CORONARY-ARTERY FROM PULMONARY-ARTERY - RECOVERY OF LEFT-VENTRICULAR FUNCTION AFTER DUAL CORONARY REPAIR

Objectives. We reviewed our institutional experience with anomalous or igin of the left coronary artery from the pulmonary artery (ALCAPA) af ter dual coronary repair to assess preoperative variables predictive o f outcome, the time course for postoperative recovery of cardiac funct ion, the short and long-term complications and our experience with lef t ventricular assist devices (LVAD) in these patients. Background. Out come after surgical repair of ALCAPA remains incompletely defined. Met hods. The surgical records and echocardiograms of 42 patients were rev iewed, Left ventricular function was assessed by fractional shortening z-score (FSz) and stress-velocity index. Results. The overall surviva l rate was 86%, All six patients who died mere <1 year old and died wi thin 3 days of the operation. More severe preoperative mitral regurgit ation (MR) was associated with increased mortality, but age, body surf ace area, preoperative FSz and end diastolic dimension were not. We us ed an LVAD for 7 of 28 patients who underwent repair for ALCAPA since its introduction at our institution, with a survival of 5 of 7 patient s, The degree of MR improved in 62% of patients and remained unchanged in 38%, Complications included supravalvar pulmonary stenosis (16 of 21 patients) and baffle leaks (11 of 21 patients) with the intrapulmon ary baffling technique, Supravalvar pulmonary stenosis developed in 1 of 11 patients after direct coronary reimplantation, Left ventricular function became normalized in all 28 patients with follow-up past 1 ye ar, regardless of preoperative FSz, Of 13 patients who underwent seria l postoperative echocardiography, the average time to normalization of function was 2 to 7 months. Conclusions. The degree of preoperative M R was predictive of outcome, whereas the severity of preoperative card iac dysfunction and ventricular dilation were not, Mild and moderate M R tended to improve without mitral valvuloplasty, Complete recovery fr om myocardial dysfunction is expected after dual coronary repair of AL CAPA. (C) 1997 by the American College of Cardiology.