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J Thorac Cardiovasc Surg 2009;137:757-759
© 2009 The American Association for Thoracic Surgery

Brief Communication

Long-term cardiac remodeling after salvage partial left ventriculectomy in an infant with anomalous left coronary artery from the pulmonary artery

Stephen Westaby, PhD, MS, FETCS, FECS, FACCa,*, Nick Archer, MDb, Saul G. Myerson, MD, MRCP, FESCc

a Department of Cardiothoracic Surgery, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
b Department of Paediatric Cardiology, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
c Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom

Received for publication December 13, 2007; revisions received February 22, 2008; accepted for publication March 23, 2008.

* Address for reprints: Dr Stephen Westaby, Dept. of Cardiothoracic Surgery, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. (Email: swestaby@ahf.org.uk).

The first 20% of the full text of this article appears below.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is an unusual cause of heart failure in infancy.1Go In this anomaly, left coronary blood flow is reversed with steal into the pulmonary artery. Repeated episodes of myocardial ischemia or infarction cause globally impaired left ventricular function and may substantially increase the risk of surgical correction. In this report, we provide late follow-up on an infant with ALCAPA, who following coronary reimplantation could not be separated from cardiopulmonary bypass. In the absence of circulatory support technology, radical left ventricular remodeling was undertaken with successful results.

Clinical Summary

A 5-month-old female infant presented with heart failure manifested by breathlessness and failure to thrive. Echocardiography demonstrated globally severely impaired left ventricular function (left ventricular ejection fraction 15%) with moderate mitral regurgitation. Coronary angiography showed ALCAPA. An operation was performed to connect the left coronary ostium with the aorta using flaps derived from the pulmonary artery and aorta. These flaps extended the left main stem.2Go Although cardioplegic solution was delivered to both right and left coronary arteries, myocardial contractility was . . . [Full Text of this Article]






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