Yu Juemin, Ren Qiushi, Chen Tianyu, Qiu Hailong, Wen Shusheng, Zhuang Jian, Liu Xiaobing
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China; School of Medicine, South China University of Technology, Guangzhou, China.
Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China; School of Medicine, South China University of Technology, Guangzhou, China.
Hellenic J Cardiol. 2023 Sep-Oct;73:47-52. doi: 10.1016/j.hjc.2023.02.003. Epub 2023 Feb 14.
This study aims to review the midterm results of surgical repair of anomalous left coronary artery from the pulmonary artery (ALCAPA) in our center and assess the postoperative cardiac function recovery and misdiagnosis.
Patients who underwent repair of ALCAPA between January 2005 and January 2022 at our hospital were retrospectively reviewed.
A total of 136 patients underwent repair of ALCAPA, among which 49.3% were misdiagnosed before referral to our hospital. On multivariable logistic regression analysis, patients with low left ventricular ejection fraction (LVEF) (odds ratio = 0.975, p = 0.018) were at increased risk for misdiagnosis. The median age at surgery was 0.83 years (range, 0.08 to 56 years), and the median LVEF was 52% (range, 5% to 86%). The mortality rate was 6.6% (n = 9), and four patients underwent reintervention. The median postoperative recovery time of left ventricular function (LVF) was 10 days (1 to 692 days). Competing risk analysis revealed that a low preoperative LVEF (hazard ratio = 1.067, p < 0.001) and age younger than 1 year (hazard ratio = 0.522, p = 0.007) were risk factors for a longer postoperative recovery time of LVF. During the follow-up period, 91.9% (113/123) of the patients had no aggravation of mitral regurgitation.
The perioperative and intermediate outcomes after ALCAPA repair were favorable, but preoperative misdiagnosis deserved attention, especially in patients with low LVEF. LVF normalized in most patients, but patients younger than 1 year and with low LVEF required longer recovery times.
本研究旨在回顾我院对左冠状动脉起源于肺动脉（ALCAPA）进行手术修复的中期结果，并评估术后心功能恢复情况及误诊情况。
对2005年1月至2022年1月期间在我院接受ALCAPA修复术的患者进行回顾性研究。
共有136例患者接受了ALCAPA修复术，其中49.3%在转诊至我院之前被误诊。多因素逻辑回归分析显示，左心室射血分数（LVEF）低的患者（比值比=0.975，p=0.018）误诊风险增加。手术时的中位年龄为0.83岁（范围为0.08至56岁），中位LVEF为52%（范围为5%至86%）。死亡率为6.6%（n=9），4例患者接受了再次干预。左心室功能（LVF）术后恢复的中位时间为10天（1至692天）。竞争风险分析显示，术前LVEF低（风险比=1.0
