Clinical Analysis And Follow-up Study Of Anomalous Origin Of The Left Coronary Artery From The Pulmonary Artery In Infants

Objective: The study aims to analyse the clinical diagnosis and treatment and follow-up results of anomalous origin of the left coronary artery from the pulmonary artery in infants.Methods: Retrospectively analysis clinical data, results of operations and follow-up results of children who visit to Beijing Children’s Hospital diagnosed of anomalous origin of the left coronary artery from the pulmonary artery from September 2006 to October 2015.Results: There were 19 cases in total, 13 cases of infant-type, adult-type in 6 cases. The surgical procedure included 8 cases directly implantation of the anomalous left coronary artery to aorta and 11 cases with implantation of the extended anomalous left coronary artery to aorta, there were four cases undergone plastic surgery of mitral valve. One patient died after surgery, and extracorporeal membrane oxygenation for one case. In infant-type cases, postoperative LVEF(54 ± 13%) compared with preoperative LVEF(42 ± 13%) were significantly improved(p = 0.004) and postoperative LVEDD(35.6 ± 6.1mm) compared with preoperative LVEDD(44.0 ± 8.5mm) were significantly reduced(p <0.001). In adult-type cases, postoperative LVEF(66 ± 7%) compared with preoperative LVEF(66 ± 3%) did not change significantly(p = 1.000) and postoperative LVEDD(36.4 ± 6.7mm) compared with preoperative LVEDD(44.3 ± 5.6mm) was significantly reduced(p <0.001). Compare two surgical procedures there were no significantdifference(p> 0.05) for the restoration of heart function. There were 4 cases with severe mitral regurgitation, 15 cases with mild to moderate mitral regurgitation. 18 cases discharged were followed up, five patients without significant mitral regurgitation, six cases of mild mitral regurgitation, six patients with moderate mitral regurgitation, 1 patient still had severe mitral regurgitation. There were no readmission surgical cases, no death, no coronary anastomotic stenosis and other complications.Conclusions: Anomalous origin of left coronary artery from the pulmonary artery often onset at younger age, symptoms are not typical, easily misdiagnosed, careful exploration of coronary with echocardiography or heart CT and reconstruction can help diagnose the disease. According to different origin of the left coronary artery, directly implantation of the anomalous left coronary artery to aorta or implantation of the extended anomalous left coronary artery to aorta the left coronary artery should be the preferred surgical procedures, patients with severe mitral stenosis should be undergone plastic surgery of actively shaped mitral valve. Application of lidocaine can help prevent and cure ventricular arrhythmias. For patients whose preoperative cardiac function is poor, unable to maintain normal blood pressue postoperative should actively take ECMO or LVAD circulatory support.