Aortic Implantation for Anomalous Connection of the Coronary Artery to the Pulmonary Artery in Older Children and Adults

Abstract

Background Anomalous connection of the coronary artery to the pulmonary artery (ACAPA) has a low incidence rate in older children and adults. The aim of this article was to evaluate the outcome of treating ACAPA with aortic implantation in older children and adults.

Methods We included 21 patients (9 children and 12 adults) with ACAPA in our hospital between January 1991 and January 2015. Among these patients, 19 had anomalous connection of the left coronary artery to the pulmonary artery, 2 had anomalous connection of the right coronary artery to the pulmonary artery (ARCAPA). All of the patients underwent aortic implantation, aged 4 to 62 years (median, 18). The mean left ventricular ejection fraction (LVEF) was 55.9 ± 7.6% (<50% in 4). Eleven patients underwent direct aortic implantation (including two ARCAPAs), while 10 patients underwent tubular implantation. Eleven patients had varying degrees of mitral regurgitation, while mitral valve plasty or replacement was performed in six patients (severe mitral regurgitation) concurrently.

Results There was no early mortality. Follow-up observation was performed in all 21 patients, with a mean follow-up time of 6.4 ± 5.6 years (ranging from 0.5 to 23 years). Two patients died due to noncardiac reasons 1 and 10 years after operation, respectively. Seven patients had mild mitral regurgitation, while no patients had moderate or severe mitral regurgitation after operations. The postoperative mean LVEF was not improved at 54.7 ± 7.0%, p > 0.05.

Conclusion Among the multiple surgical strategies for the treatment of ACAPA, aortic implantation was used commonly in older children and adults, while mitral valve repair can be performed concurrently.

Keywords

aortic implantation - anomalous connection - congenital heart disease - mitral valve replacement

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