Departamento de Cirugía Cardiaca Pediátrica y Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, México D.F., México.
Rev Esp Cardiol. 2011 Aug;64(8):681-7. doi: 10.1016/j.recesp.2011.04.015. Epub 2011 Jun 28.
We report our experience in the surgical correction of anomalous origin of left coronary artery from pulmonary artery (ALCAPA), with an emphasis on the coronary reimplantation technique and its outcome.
We designed a retrospective, longitudinal, descriptive study that included patients with ALCAPA who underwent surgery involving coronary reimplantation over a 19-year period. We describe perioperative details such as variations in the surgical technique and the postoperative outcome in terms of morbidity and mortality.
We studied 15 patients (86% females) with a mean age of 6.2 years (range, 2 months to 24 years). Heart failure was the principal cause for hospitalization in 80% of our patients. Left ventricular dysfunction was present in 67%, and 27% had significant or severe mitral valve regurgitation. We describe 3 surgical techniques for coronary reimplantation, the choice of which depends on the site of origin of the anomalous left coronary artery. Four patients underwent an additional mitral valve procedure. The most common immediate postoperative complications were low cardiac output (38%), pleural effusion (17%), and transient ischemia (13%). There was no operative or medium-term mortality.
Coronary reimplantation is the technique of choice for surgical correction of ALCAPA due to the excellent postoperative survival and low operative morbidity.
我们报告了我们在手术矫正左冠状动脉异常起源于肺动脉（ALCAPA）方面的经验，重点介绍了冠状动脉再植入技术及其结果。
我们设计了一项回顾性、纵向、描述性研究，纳入了 19 年间接受冠状动脉再植入手术的 ALCAPA 患者。我们描述了围手术期的细节，如手术技术的变化以及发病率和死亡率方面的术后结果。
我们研究了 15 名患者（86%为女性），平均年龄为 6.2 岁（范围为 2 个月至 24 岁）。心力衰竭是 80%患者住院的主要原因。67%的患者存在左心室功能障碍，27%的患者存在明显或严重的二尖瓣反流。我们描述了 3 种冠状动脉再植入手术技术，选择哪种技术取决于异常左冠状动脉的起源部位。4 名患者接受了额外的二尖瓣手术。最常见的术后即刻并发症是低心输出量（38%）、胸腔积液（17%）和短暂性缺血（13%）。无手术或中期死亡。
由于术后生存良好且手术发病率低，冠状动脉再植入是 ALCAPA 手术矫正的首选技术。
