Reimplantation of Anomalous Left Coronary Artery From the Pulmonary Artery Without Mitral Valve Repair

Background Early establishment of a two-coronary artery system has become the standard surgical approach in patients with anomalous origin of the left coronary artery from the pulmonary artery. Improved surgical outcome is related to better perioperative management and surgical techniques. The need for mitral valve repair is still controversial, however. We report our long-term results with aortic implantation of the left coronary artery. Methods Between January 1992 and July 2005, 23 patients who had severe left ventricular dysfunction and mitral insufficiency underwent aortic implantation of the left coronary artery. Mean age and weight were 5 ± 3 months (range, 2 to 14 months) and 5 ± 1.5 kg (range, 3.2 to 7 kg). Repair was accomplished by creating a wide anastomosis between the left coronary artery and aorta that was augmented with autologous pericardium to avoid tension and distortion of the anastomosis. None of the patients had concomitant mitral valve repair. Results There were no operative or late deaths. One patient required extracorporeal membrane oxygenation for 86 hours and another for 100 hours because of sustained ventricular tachycardia and respiratory insufficiency. A younger age (<6 months) was associated with a longer stay in the intensive care unit (p = 0.04). During a mean follow-up of 78 ± 30 months (range, 6 to 156 months) all patients were in the New York Heart Association functional class I. Serial echocardiograms showed complete recovery of left ventricular function in all patients within 6 months. Mitral valve function was normal in 17 patients and mildly impaired in 6. The mean shortening fraction increased from 0.2 ± 0.05 preoperatively to 0.43 ± 0.07 postoperatively (p = 0.03), and left ventricular end-diastolic dimension decreased from 44 ± 7 mm preoperatively to 29 ± 8 mm postoperatively (p = 0.02). Conclusions Aortic implantation of the left coronary artery results in complete recovery of left ventricular function and no late mitral valve dysfunction.