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J Thorac Cardiovasc Surg 1999;117:332-342
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

EXCELLENT LONG-TERM FUNCTIONAL OUTCOME AFTER AN OPERATION FOR ANOMALOUS LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY

From the Victorian Pediatric Cardiac Surgery Unit, Department of Cardiology, and Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Melbourne, Australia.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 8, 1998. revisions requested June 5, 1998. revisions received Sept 16, 1998. Accepted for publication Sept 16, 1998. Address for reprints: A. D. Cochrane, MBBS, FRACS, FRCS (CTh), Department of Pediatric Cardiac Surgery, Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia.

Objective: The aim of this study was to review the results of operations for anomalous left coronary artery from the pulmonary artery and the late outcome for exercise capacity, left ventricular function, and mitral regurgitation.
Methods: Twenty-one patients underwent operations over an 18-year period (median age, 9 months; range, 6 weeks–26 years) with a median follow-up of 6.5 years (range, 2 months–18 years). In addition to clinical and echocardiographic follow-up, patients at our institution were also investigated with radionuclide scans (n = 10) and treadmill exercise testing (n = 8).
Results: There were no operative or late deaths (0%; 95% confidence interval [CI], 0% and 16%). Five patients required support with a left ventricular assist device. Eighteen patients are currently in New York Heart Association class I, and 3 patients are mildly symptomatic. On nuclear gated scan at a mean of 6 years after the operation, the left ventricular ejection fraction was 64% (SD, 3%) at rest and increased to 74% (SD = 3%) on exercise (95% CI for the difference, 6%, 14%; P = .001). Treadmill endurance was normal for age (9.8-14.5 minutes) in those old enough to exercise. On echocardiography (n = 18), the current fractional shortening was 34% (SD, 4%) in the 15 patients with normal or only mildly abnormal ventricular septal motion. Three patients have undergone mitral valve operations. The left ventricular end-diastolic dimension fell from 48 mm (SD, 5.8 mm) before surgery to 35.1 mm (SD, 5.2 mm) at 1 year after the operation, and the fractional shortening increased over the first year from 19.6% (SD, 9.3%) to 32.8% (SD, 5.9%; both P < .001).
Conclusions: Long-term clinical outcome and left ventricular function are good, despite severe left ventricular dysfunction at presentation.

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