Saito Tetsuya, Kawamura Masashi, Toda Koichi, Miyagawa Shigeru
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan, 565-0871.
Eur Heart J Case Rep. 2023 Jul 21;7(8):ytad340. doi: 10.1093/ehjcr/ytad340. eCollection 2023 Aug.
The number of diagnosed cases of anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) in adults has increased substantially because of modern advances in non-invasive cardiac imaging. Here, we report successful surgical repair in an adult patient with ALCAPA complicated by severe mitral regurgitation (MR) and persistent atrial fibrillation.
ALCAPA syndrome was detected in a 65-year-old Asian woman with persistent atrial fibrillation by coronary computed tomographic angiography. An echocardiogram revealed severe MR caused by annular dilation, atrial enlargement, and posterior mitral leaflet tethering. In addition to ALCAPA repair, mitral valve repair and Cox-Maze IV cryoablation were performed. Mitral valve repair was performed using augmentation with an autologous pericardial patch in the posterior leaflet and ring annuloplasty.
Because the mechanism of MR with ALCAPA in an adult varies by comorbidity, mitral valve repair should be performed according to the valvular and subvalvular morphologies. It is essential to develop strategies that provide adequate myocardial protection during the surgical treatment of ALCAPA considering coronary steal and non-coronary collateral blood flow.
由于无创心脏成像技术的现代进展，成人左主冠状动脉起源于肺动脉（ALCAPA）的确诊病例数大幅增加。在此，我们报告一例成年ALCAPA患者合并严重二尖瓣反流（MR）和持续性心房颤动的成功手术修复病例。
一名65岁患有持续性心房颤动的亚洲女性通过冠状动脉计算机断层血管造影检测出ALCAPA综合征。超声心动图显示，由于瓣环扩张、心房扩大和二尖瓣后叶牵拉导致严重MR。除了进行ALCAPA修复外，还进行了二尖瓣修复和Cox-Maze IV冷冻消融术。二尖瓣修复采用自体心包补片在后叶进行增强修复及瓣环成形术。
由于成人ALCAPA合并MR的机制因合并症而异，二尖瓣修复应根据瓣膜和瓣膜下形态进行。在考虑冠状动脉窃血和非冠状动脉侧支血流的情况下，制定在ALCAPA手术治疗期间提供充分心肌保护的策略至关重要。
