| Objective: To investigate the clinical manifestations,surgical methods and prognosis of anomalous origin of the left coronary artery from the pulmonary artery.Methods: Clinical data of 91 ALCAPA patients cured in Shanghai Children's Medical Center from March 2010 to August 2017 were conducted retrospective analysis.According to the cardiac functions situations in the treatment,these patients were divided into the normal cardiac function group(37 patients)and cardiac insufficiency group(54patients).Clinical features(age of onset and clinical performance),auxiliary examination(ECG and cardiac ultrasound),operation results of patients in both groups were analyzed and compared.Prognosis were analyzed by Pearson correlation coefficient.Differences between groups were analyzed by independent sample t-test.The difference in incidence was analyzed by chi-square test,and the prognostic factors were analyzed by orderly logistic regression analysis.Results:(1)Patients in the cardiac insufficiency group had shortness of breath,hidrosis,feeding difficulty and lagging growth development in early stage.The average age of definite diagnosis was 10 months;Patients in normal cardiac function group had no obvious symptoms.,The average age of definite diagnosis was 40 months.Divided by the pathophysiological cycle,74%(40/54 patients)of the cardiac insufficiency group were infantile type,and 78% of the normal cardiac function group(29/37 cases)were adult type.(2)The preoperative electrocardiogram of the two groups showed more deep Q wave and T wave inversion in the lead of left chest.Among them,the deep Q wave of I lead was 11 cases in the normal heart function group and 26 cases in the cardiac insufficiency group.The difference was statistically significant(P=0.021,Z=2.302)(3)77 patients accepted remedy of surgery.Patients in the normal cardiac function group were attached with more mitral valvuloplasty than the cardiac insufficiency group;Average length of hospital stay,delayed chest closures and deaths in cardiac insufficiency group were obviously more than the normal cardiac function group,and the difference was statistically significant(P<0.05)(4)20 patients passed away in the cardiac insufficiency group and belonged to the infantile type.8 patients died of postoperative cardiac pump failure,while 12patients died of no surgery for various causes.The normal cardiac function group had no death.(5)Preoperative LVEF is positively correlated with age in the normal cardiac function group(P=0.030,R=0.334);In the group of patients with cardiac insufficiency,There was a significant positive correlation between preoperative LVEF and the age of diagnosis(P=0.029,R=0.334),and a significant positive correlation between preoperative cardiac function and postoperative cardiac function(P=0.000,R=0.52).(6)In the postoperative follow-up visiting,Preoperative LVEF was the only factor affecting prognosis,and the difference was statistically significant(F=16.872,P=0.005).The preoperative left ventricular ejection fraction was(37.3±11.2)%in the group of patients with cardiac insufficiency and(45.2±14.3)%after surgery,and the difference was statistically significant(P=0.001,t=3.614).Among the 34 patients who were discharged from the cardiac dysfunction group,27 of them had normal cardiac function,and the other 6 patients with low cardiac function were infantile type.Postoperative cardiac function follow-up visiting in normal cardiac function group was normal.3 patients had the larger heart.2 patients who didn't accept operation belonged to the adult type.Their cardiac function was normal.Conclusions:The clinical manifestations,misdiagnosis methods and disease prognosis are different between infantile type and adult type;Once diagnosed,surgery should be performed as soon as possible.Perioperative mortality is higher in children with low cardiac function before surgery,and postoperative follow-up is favorable.Part of infantile type patients have the lower cardiac function continuously and require long-term standardized follow-up treatment. |
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