Document Detail

ALCAPA: the role of myocardial viability studies in determining prognosis.
MedLine Citation:
PMID:  19795113     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: ALCAPA is optimally treated by coronary artery reimplantation early in neonatal life. Delayed diagnosis, however, is not infrequent, because symptoms often do not manifest until about 3 months of age, coinciding with the physiological nadir in pulmonary vascular resistance. With delayed diagnosis, there is potential for coronary steal and irreversible myocardial injury, which worsens outcome. OBJECTIVE: To assess the utility of MRI in determining prognosis in children with surgically corrected ALCAPA. MATERIALS AND METHODS: A retrospective chart review was performed in two children with ALCAPA who underwent coronary reimplantation and postoperative cardiac MRI. Both children subsequently underwent cardiac transplantation. The imaging findings and pathological findings at explant are presented. RESULTS: In both children, there was severe, globally depressed left ventricular systolic function and abnormal delayed enhancement in a predominantly subendocardial distribution. Pathological examination of the cardiac explants showed extensive fibrotic tissue, which correlated with areas of abnormal delayed enhancement on MRI. CONCLUSION: Severe reduction in systolic function and presence of delayed enhancement indicate extensive myocardial injury and pathologically correlate with irreversible fibrotic changes, which may help identify a subgroup of children who will not recover ventricular function and ultimately require heart transplantation.
Lorna P Browne; Debra Kearney; Michael D Taylor; Taylor Chung; Timothy C Slesnick; Arni C Nutting; Rajesh Krishnamurthy
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-10-01
Journal Detail:
Title:  Pediatric radiology     Volume:  40     ISSN:  1432-1998     ISO Abbreviation:  Pediatr Radiol     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-21     Completed Date:  2010-04-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0365332     Medline TA:  Pediatr Radiol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  163-7     Citation Subset:  IM    
Department of Diagnostic Imaging, Texas Children's Hospital, 6621 Fannin St., Houston, TX 77030, USA.
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MeSH Terms
Abnormalities, Multiple / diagnosis*
Coronary Vessel Anomalies / diagnosis*
Magnetic Resonance Imaging, Cine / methods*
Myocardial Stunning / congenital*,  diagnosis*
Pulmonary Artery / abnormalities*,  pathology*

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