Published in:
01-01-2009 | From Other Journals
From Other Journals
Journal Review Editors: Ahmed Alomrani, Sanjiv Gandhi, Omar M. Khalid
Published in: Pediatric Cardiology | Issue 1/2009
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In this paper, the authors examined the influence of the degree of preoperative mitral regurgitation on the early and late outcomes of patients with anomalous origin of the left coronary artery from the pulmonary artery who underwent coronary reimplantation. Twenty-five patients underwent coronary reimplantation and 1 early patient had ligation during a 30-year period (median age, 4 months; range, 1 month to 16 years), with a median follow-up of 7 years (range, 4 months to 25 years). Before repair, 7 infants (27%) presented in extremis, requiring ventilatory and inotropic support, and 17 patients (65%) presented with heart failure. Mitral regurgitation was moderate in 5 patients and severe in 3 patients. No patient underwent mitral valve intervention at the time of repair of anomalous origin of the left coronary artery from the pulmonary artery. Hospital survival was 92%. Three patients underwent mitral valve repair or replacement at a mean time of 3.5 years (all with severe preoperative mitral regurgitation). The degree of mitral regurgitation gradually improved in all remaining patients. Echocardiographic studies demonstrated improvement in left ventricular function in all children. None of the patients showed any evidence of supravalvar pulmonary stenosis as a result of their pulmonary artery reconstruction.-
In repaired patients with anomalous origin of the left coronary artery from the pulmonary artery, long-term clinical outcomes and left ventricular function are good. Prior to correction, this entity causes severe myocardial ischemia, global left ventricular dysfunction, and annular dilatation, producing varying degrees of mitral regurgitation. This series emphasizes that mitral valve repair or replacement is not necessary at the time initial surgical repair and is potentially harmful by acutely increasing left ventricular afterload in these sick ventricles. Rarely, significant residual mitral regurgitation persists in some patients and can be managed surgically at a later date depending on its degree of severity, at a time when the left ventricle has improved or returned to normal function.