The Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA): a Case Series and Brief Review

Authors

1 Assistant professor, Department of cardiac surgery, Atherosclerosis Prevention Research Center Faculty of medical science, Mashhad University of Medical Sciences, Iran

2 Associated Professor, Department of cardiac surgery, Atherosclerosis Prevention Research Center, Faculty of medical science, Imam Reza Hospital, Mashhad University of Medical Sciences, Iran

3 Associated professor of pediatric cardiology,. Mashhad University of Medical Sciences, Mashhad, Iran

4 Associated Professor, Department of anesthesiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Iran

5 Resident of Anesthesiology, Department of anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran

6 Resident of Neurosurgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Background
Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiovascular defect that occurs in approximately 1/300 000 live births or 0.5% of children with congenital heart disease. There are two types of ALCAPA syndrome: the infant type and the adult type. The most infants experience myocardial infarction and congestive heart failure, and approximately 90% die within the first year of life; also, without early surgical intervention they have a dismal prognosis.
Materials and Methods
We report 3- year experiences from January 2013 to January 2016 of Imam Reza Hospital center (a tertiary referral hospital North East of Iran) that consist of all patients with ALCAPA syndrome.
Results
The Takeuchi procedure, were successfully performed in five children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). There was no death and significant mitral regurgitation postoperative (n=0) in this short study. All of patients (n=5) had evidence of improving ischemic myocardium status by increasing of ejection fraction and regional wall motion of left ventricular in follow up echocardiography.
Conclusion
The only cure treatment for ALCAPA syndrome is surgical intervention that needs to be performed immediately after diagnosis to prevent myocardial infarction and chronic heart failure. Today, establishing a system with two coronary arteries is the goal in definitive surgical repair. The Takeuchi procedure is a prefer method to establish a two-coronary repair for ALCAPA.

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