Origen anómalo de la coronaria izquierda en la arteria;
Outcomes after Surgical Correction of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

RESUMENIntroducciónEl origen anómalo de la arteria coronaria izquierda en la arteria pulmonar es una cardiopatía congénita rara que produce isquemia miocárdica con disfunción ventricular izquierda e insuficiencia mitral de grado variable. Las técnicas actuales han modificado la historia natural de esta enfermedad mediante el restablecimiento de un sistema de doble irrigación coronaria.ObjetivosEvaluar la experiencia institucional en la corrección quirúrgica del origen anómalo de la coronaria izquierda en la arteria pulmonar.Material y métodosEntre febrero de 2000 y mayo de 2008 fueron operados 13 pacientes con este diagnóstico. Seis eran menores de 1 año; mediana: 2,5 años; rango: 45 días a 21 años. Antes de la cirugía, el 61% de los pacientes presentaban insuficiencia cardíaca, el 69% signos de infarto y el 84% cardiomegalia moderada a grave. La fracción de acortamiento promedio era del 26,07% y existía insuficiencia mitral moderada a grave en el 46% de los casos. El diagnóstico se confirmó por cateterismo en 11 pacientes.

SUMMARYBackgroundThe anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital heart defect that produces myocardial ischemia with left ventricular dysfunction and mitral regurgitation. The natural history of the disease has been modified by the current surgical techniques which establish a system with two coronary arteries.ObjectivesTo evaluate our experience with the surgical correction of the anomalous origin of the left coronary artery from the pulmonary artery.Material and MethodsA total of 13 patients underwent surgical repair of this condition from February 2000 to May 2008. Median age was 2.5 years; range 45 days to 21 years. Six patients were <1 year old. Before surgery, 61% of patients presented congestive heart failure, 69% had signs of myocardial infarction and 84% moderate to severe heart enlargement. Average shortening fraction was 26.07% and 46% of patients had moderate to severe mitral regurgitation. The diagnosis was confirmed by coronary angiography in 11 patients.The Takeuchi procedure was performed in one patient and 12 patients underwent direct anastomosis of the anomalous left coronary artery directly to the aorta. One patient underwent mitral valve repair. Perfusion of the anomalous coronary artery and cardioplegia were provided via the pulmonary artery in six patients.ResultsAt present, after a mean follow-up of 74.76 months, mortality rate is 0%. None of the patients presented congestive heart failure at discharge. A reduction in cardiac size was observed in 9/11 patients. The average postoperative shortening fraction was 39.92%. A decrease in the severity of mitral regurgitation was observed in all patients with only one exception. None of the patients presented severe mitral regurgitation in the late postoperative period.ConclusionsThe outcomes of the surgical correction of the anomalous origin of the left main coronary artery from the pulmonary artery are excellent in all age groups, with significant improvement of myocardial function and reduction of the severity of mitral regurgitation in most patients