Castaldi Biagio, Vida Vladimiro, Reffo Elena, Padalino Massimo, Daniels Queenette, Stellin Giovanni, Milanesi Ornella
Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, via Giustiniani 3, 35128, Padua, Italy.
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Pediatr Cardiol. 2017 Apr;38(4):794-800. doi: 10.1007/s00246-017-1583-z. Epub 2017 Feb 18.
Surgical re-implantation of the left coronary artery (LCA) is the treatment of choice in anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Despite normalization of left ventricular function after surgery, residual coronary lesions or myocardial fibrosis may be found. The aim of this study was to detect regional left ventricular dysfunction predictive of coronary lesions or residual myocardial fibrosis using speckle tracking. We enrolled ten patients treated with surgical re-implantation of LCA for ALCAPA. All patients were asymptomatic, and ejection fraction (EF) was normal. Using S-SR imaging, we studied longitudinal, radial, and circumferential function. A cardiac MRI was performed to assess myocardial fibrosis and the anatomy of the coronaries. In case of suspected coronary stenosis, a coronary angiography was performed. Finally, 20 normal subjects were enrolled as control group. Median age at surgery was 188 days, and mean follow-up was 8.7 ± 4.7 years. Longitudinal and circumferential functions were reduced in LCA territory compared to RCA territory and normal. MRI showed LCA stenosis in three of ten patients, confirmed by coronary angiography: these patients had the lowest longitudinal strain values in LCA territories (-11.7, -14.7 and -14.8%). Radial strain was preserved (Normal 45.6 ± 12.1, ALCAPA 43.5 ± 10.7%, p = ns), while circumferential strain was mildly depressed (-23.5 ± 3.8 vs. -20.3 ± 2.0%, p < 0.05). After LCA re-implantation, ALCAPA patients showed a residual sub-endocardial damage in LCA territories. Despite a normal systolic and diastolic function, the prevalence of residual coronary lesions was high. A mean longitudinal strain >-15% in LCA territories was able to identify those patients.
左冠状动脉（LCA）手术再植入是治疗左冠状动脉起源于肺动脉（ALCAPA）异常的首选方法。尽管手术后左心室功能恢复正常，但仍可能发现残留的冠状动脉病变或心肌纤维化。本研究的目的是使用斑点追踪检测预测冠状动脉病变或残留心肌纤维化的局部左心室功能障碍。我们纳入了10例接受LCA手术再植入治疗ALCAPA的患者。所有患者均无症状，射血分数（EF）正常。使用S-SR成像，我们研究了纵向、径向和圆周功能。进行心脏MRI以评估心肌纤维化和冠状动脉解剖结构。怀疑冠状动脉狭窄时，进行冠状动脉造影。最后，纳入20名正常受试者作为对照组。手术时的中位年龄为188天，平均随访时间为8.7±4.7年。与右冠状动脉区域和正常区域相比，LCA区域的纵向和圆周功能降低。MRI显示10例患者中有3例存在LCA狭窄，冠状动脉造影证实：这些患者在LCA区域的纵向应变值最低（-11.7%、-14.7%和-14.8%）。径向应变得以保留（正常组45.6±12.1，ALCAPA组43.5±10.7%，p=无统计学意义），而圆周应变轻度降低（-23.5±3.8对-20.3±2.0%，p<0.05）。LCA再植入后，ALCAPA患者在LCA区域显示出残留的心内膜下损伤。尽管收缩和舒张功能正常，但残留冠状动脉病变的发生率很高。LCA区域平均纵向应变>-15%能够识别出这些患者。
