Xu Jian-ping, Guo Hong-wei, Hu Sheng-shou, Sun Li-zhong, Song Yun-hu, Sun Han-song
Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Wai Ke Za Zhi. 2006 Nov 15;44(22):1525-8.
To evaluate effectiveness of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery.
Between April 1999 and August 2005, 12 patients with anomalous origin of the coronary artery from the pulmonary artery underwent surgical correction. There were 8 patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), and 4 patients with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). Eight patients underwent direct aortic reimplantation, and 4 patients underwent a Takeuchi procedure (intrapulmonary artery baffle with an autologous pericardial patch). Simultaneous mitral annuloplasty was performed in 7 patients of ALCAPA with moderate and severe mitral regurgitation. One patient of ARCAPA was associated with an atrial septal defect (ASD) which was closed with an amplatzer septal occluder through right atrium under transesophageal echocardiography (TEE) without CPB.
There were neither early and late deaths nor postoperative complications. Follow-up of all patients ranged from 7 to 83 months (mean, 32 +/- 24 months). The left ventricular function after operation improved from a preoperative fractional shortening (FS) of 0.21 +/- 0.09 to 0.35 +/- 0.06 (P = 0.006) for patients with ALCAPA. Preoperative mitral regurgitation decreased in 7 patients of ALCAPA after mitral annuloplasty at the follow-up. All patients were doing well and their exercise tolerance improved to normal. They were free from symptoms.
Reestablishment of a two-coronary system is necessary for patients with anomalous origin of the coronary artery from the pulmonary artery. The left ventricular function improved after 2-coronary repair. We recommend that the simultaneous mitral annuloplasty should be performed at the time of operation for patients who have moderate and severe mitral regurgitation with ALCAPA. Surgical correction of ARCAPA and ARCAPA show good early and mid-term results, long-term results need to be followed up.
评估肺动脉起源异常的冠状动脉患者手术矫正的效果。
1999年4月至2005年8月期间，12例肺动脉起源异常的冠状动脉患者接受了手术矫正。其中8例为左冠状动脉起源于肺动脉（ALCAPA），4例为右冠状动脉起源于肺动脉（ARCAPA）。8例患者接受了直接主动脉再植入术，4例患者接受了竹内手术（用自体心包补片构建肺内动脉挡板）。7例中度和重度二尖瓣反流的ALCAPA患者同时进行了二尖瓣环成形术。1例ARCAPA患者合并房间隔缺损（ASD），在经食管超声心动图（TEE）引导下，在非体外循环下经右心房用Amplatzer封堵器关闭了该缺损。
无早期和晚期死亡病例，也无术后并发症。所有患者的随访时间为7至83个月（平均32±24个月）。ALCAPA患者术后左心室功能从术前的短轴缩短率（FS）0.21±0.09提高到0.35±0.06（P = 0.006）。随访时，7例ALCAPA患者在二尖瓣环成形术后二尖瓣反流减轻。所有患者情况良好，运动耐量恢复正常，无症状。
对于肺动脉起源异常的冠状动脉患者，重建双冠状动脉系统是必要的。双冠状动脉修复后左心室功能改善。我们建议，对于合并中度和重度二尖瓣反流的ALCAPA患者，手术时应同时进行二尖瓣环成形术。ARCAPA的手术矫正显示出良好的早期和中期效果，长期效果有待随访。
