BẤT THƯỜNG XUẤT PHÁT ĐỘNG MẠCH VÀNH TRÁI TỪ ĐỘNG MẠCH PHỔI: KẾT QUẢ ĐIỀU TRỊ PHẪU THUẬT 60 TRƯỜNG HỢP TẠI BỆNH VIỆN NHI TRUNG ƯƠNG

Abstract

Objective: Evaluate the midterm outcomes of surgical repair for patients diagnosed with anomalous origin of the left coronary artery from pulmonary artery (ALCAPA). Methods: From June 2011 to January 2021, a consecutive of 60 patients diagnosed with ALCAPA who underwent surgical repair using direct reimplantation of the left coronary artery to the aorta at Vietnam National Children’s Hospital were retrospectively reviewed. Results: The mean weight and mean weight of patients in our study were 5.8 ± 2.1 kg and 6.8 ± 12.4 months. The gender of patients was 25 male/35 female. There were 4 patients (6.7%) associated with intracardiac lesions included: tetralogy of Fallot (2 patients), ventricular septal defect (1 patient), and coratriatum-coarctation of the aorta (1 patient). Preoperative echocardiography showed 21 patients had more than moderate mitral valve regurgitation, and mean left ventricular ejection fraction of 39.5 ± 15.7% (14%-76%). Intraoperative anatomy showed 48 patients (80%) had the left coronary artery origin from the facing sinus of Valsalva, 7 patients (11.7%) origin from the non-facing sinus, and 5 patients (8.3%) origin from the main pulmonary trunk or the right pulmonary artery. Direct implantation of the left coronary artery to the aorta was performed in 51 patients (85%), and an autologous extrapulmonary tunnel was created in 9 patients (15%). There were 3 patients (5%) died in hospital, and no late mortality. Four patients (7%) required cardiac reoperation during follow-up, with 3 patients having NYHA 2, and the remaining 54 patients having NYHA 1. Conclusions: Midterm outcomes of ALCAPA repair at Vietnam National Children's Hospital were excellent. Further investigations with longer follow-up of myocardial contractility and mitral valve function are necessary.