Document Detail


Anomalous origin of the left coronary artery from the pulmonary artery associated with severe left ventricular dysfunction: results in normothermia.
MedLine Citation:
PMID:  20732507     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) carries a high risk of operation, particularly in those with poor left ventricular function. In this study, we assessed the outcomes of patients who presented with severe preoperative left ventricular dysfunction (shortening fraction <15%) who underwent the repair under normothermic bypass. METHODS: Since September 2002, 21 infants with severe left ventricular dysfunction underwent surgical repair using a direct coronary reimplantation technique. Mean age of patients was 5.3 +/- 3.8 months. Moderate or severe mitral regurgitation present in 5 patients was not addressed at the operation. Repair was performed under normothermic cardiopulmonary bypass and myocardial protection was achieved by intermittent antegrade normothermic blood cardioplegia. RESULTS: Mean cardiopulmonary bypass and cross-clamp times were 153.5 +/- 51 and 50 +/- 14.5 minutes, respectively. There was one (4.7%) early death because of sudden cardiac arrest 48 hours after successful weaning from mechanical ventilation. One patient required urgent left coronary artery stenting on the 34th postoperative day because of early reimplantation failure. There was no late death. Echocardiographic evaluation revealed a significant improvement in terms of shortening fraction (preoperative, 10.3 +/- 3.2% vs follow-up, 33 +/- 7.7%, p < 0.0001). CONCLUSIONS: Our results suggest that the repair of anomalous origin of the left coronary artery from the pulmonary artery can be accomplished with acceptable mortality and morbidity rates even in patients having severely depressed left ventricular function. Normothermic cardiopulmonary bypass is safe and effective in children who have a limited tolerance to further ischemic insult.
Authors:
Emre Belli; Régine Roussin; Mohammed Ly; François Roubertie; Emmanuel Le Bret; Murat Basaran; Alain Serraf
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-24     Completed Date:  2010-09-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  856-60     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, University Paris-Sud, Le Plessis-Robinson, France. e.belli@ccml.fr
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MeSH Terms
Descriptor/Qualifier:
Cardiopulmonary Bypass / methods
Coronary Vessel Anomalies / complications*,  surgery*
Heart Arrest, Induced
Humans
Infant
Pulmonary Artery / abnormalities*,  surgery*
Severity of Illness Index
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left / complications*
Comments/Corrections
Comment In:
Ann Thorac Surg. 2010 Sep;90(3):860-1   [PMID:  20732508 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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