Cor Vasa 2003, 44(7-8):357-359

The fate of patients following left coronary artery ligation because of its anomalous origin from the pulmonary artery

Martin Wiendl^1,*, Marie Gebauerová¹, Bronislav Janek¹, Tomáš Marek¹, Kateřina Lefflerová¹, Roman Gebauer², Bohumil Hučín², Vladimír Staněk¹

¹ Klinika kardiologie, Institut klinické a experimentální medicíny

² Dětské kardiocentrum, Fakultní nemocnice Motol a 2. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Introduction:
The fate of patients with a left coronary artery (LCA) origin anomaly treated by LCA branch ligation is not known. The present study evaluated the outcome of 12 patients treated in early childhood by LCA ligation because of its anomalous origin from the pulmonary artery at two Prague-based centers, the Institute for Clinical and Experimental Medicine and the Pediatric Heart Center in Motol University Hospital.

Method:
Using noninvasive techniques (echocardiography, ergometry, Holter monitoring, EKG monitoring, late ventricular potential testing), we examined all surviving patients at IKEM; 3 patients had invasive tests (selective coronary angiography, with electrophysiological testing performed in one patient).

Results:
Mortality was 50% in our group. Five of the six living patients showed signs of myocardial ischemia, only one patient had physiological findings from the above examinations. One patient at increased risk of sudden death was scheduled for myocardial revascularization.

Conclusions:
Our findings support data of most published studies in concluding that early LCA ligation in these patients is not a definitive therapeutic option because of persisting myocardial ischemia and, hence, the risk of sudden death.

Keywords: Anomalous origin of the main left coronary artery from the pulmonary artery; LCA ligation; Takeuchi procedure; LCA reimplantation into the aorta

Published: July 1, 2003  Show citation