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J Thorac Cardiovasc Surg 2001;122:635-636
© 2001 The American Association for Thoracic Surgery

Letters to the Editor

Surgical intervention for anomalous origin of the left coronary artery from the pulmonary artery

Deutsches Herzzentrum Berlin,Augustenburger Platz 1,
13353 Berlin, Germany

To the Editor:

We read with interest the article by Isomatsu and associates ¹ about surgery for anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). We agree that many patients with associated mitral incompetence need simultaneous mitral valve reconstruction, but we do not agree that all patients with mitral incompetence should undergo mitral valve surgery during coronary reimplantation.

On page 795 the authors, citing our article ² among others, write: "The first 3 reports with no mortality had relatively small numbers of patients." Mortality in the infant group reported by Isomatsu and associates was 22% (2/9 patients). Our experience now includes 20 pediatric patients with ALCAPA (9 infants and 11 older children). Preoperatively, 5 patients had moderate and 5 severe mitral valve incompetence. All of our patients underwent direct reimplantation of the ALCAPA into the aorta, irrespective of its origin from the pulmonary artery (origin from right facing pulmonary sinus was observed in 11 patients, from nonfacing sinus in 6 patients, and from pulmonary bifurcation or the right or left pulmonary artery in 1 patient each).

Mitral valve reconstruction was performed only in patients with severe mitral incompetence.

A centrifugal left ventricular pump was used because of severe left ventricular dysfunction postoperatively in 3 infant patients. There was no postoperative or late mortality. Follow-up examinations (13 to 160 months postoperatively) in all patients showed absence of moderate or severe mitral valve incompetence. Among 5 patients with severe mitral incompetence preoperatively, in 3 it was mild and in 2 it was absent during follow-up.

Our results showed that direct coronary reimplantation is possible in all pediatric patients with ALCAPA. Contrary to Isomatsu and colleagues, we recommend mitral valve reconstruction only in patients with severe incompetence, because in patients with mild and moderate mitral incompetence, improvement of mitral valve function can be expected after coronary reimplantation.

Temporary use of a centrifugal left ventricular pump plays a major role in decreasing postoperative mortality in infants with severe left ventricular dysfunction.

12/8/118045

doi:10.1067/mtc.2001.118045

References

1. Isomatsu Y, Imai Y, Shin'oka T, Aoki M, Iwata Y. Surgical intervention for anomalous origin of the left coronary artery from the pulmonary artery: the Tokyo experience. J Thorac Cardiovasc Surg. 2001;121:792-7.[Abstract/Free Full Text]
   
2. Alexi-Meskishvili V, Hetzer R, Weng Y, Lange PE, Jin Z, Berger F, et al. Anomalous origin of the left coronary artery from the pulmonary artery: early results with direct aortic reimplantation. J Thorac Cardiovasc Surg. 1994;108:354-62.[Abstract/Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Vladimir Alexi-Meskishvili Roland Hetzer Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Alexi-Meskishvili, V. Articles by Hetzer, R. Search for Related Content PubMed PubMed Citation Articles by Alexi-Meskishvili, V. Articles by Hetzer, R.