The left coronary artery arising from the pulmonary artery (ALCAPA) is a rare congenital anomaly. It causes high mortality if untreated in childhood. Only 10% to 15% of patients reach adulthood. We report a successful repair of ALCAPA in an adult with a rolled-conduit-extended-reimplantation technique. The procedure is easily applicable and has technical advantages for creating a longer and wider conduit and may decrease bleeding. (J Card Surg 2011;26:604-607)

Repair of Anomalous Origin of the Left Coronary Artery Arising from Right Pulmonary Artery with Rolled-Conduit-Extended Reimplantation in an Adult

Background: For the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA. Methods: Between October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed. Results: There was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement. Conclusion: Our modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA.

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관상동맥-폐동맥 이상기시증(Anomalous Origin of Coronary Artery from Pulmonary Artery)의 수술적 치료