Melanie Holtrup

Objective: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly resulting in myocardial ischemia, global left ventricular (LV) dysfunction, and mitral regurgitation (MR). Surgical placement of a pulmonary artery band (PAB) at ALCAPA repair may assist with recovery of patients with severe LV dysfunction. We assessed the outcomes of patients with ALCAPA and severe dysfunction treated with, and without a PAB. Methods: We performed a retrospective analysis of cases presented to our center between January 2007 and December 2023. Baseline and follow-up data were collected from records. Ventricular function was assessed by standardized transthoracic echocardiogram. Results: Twenty-six patients underwent ALCAPA repair at a median age of 4 months (range 19 days-8 years). Surgery was performed by direct coronary reimplantation in all patients. Beginning in 2017, we have placedan adjustable PAB in 5 patients with severe LV dysfunction (Conclusion: There is marked improvement of MR grade and LV function, and no mortality during a 10-year period in the group with EF > 25%. Patients with EF < 25% treated with a PAB demonstrated an improved trajectory toward EF improvement, achieving normal function earlier than those without PA band. Temporary adjustable PAB may be beneficial in ALCAPA patients with severe dysfunction.

Purpose: Some centers including ours have used glutaraldehyde-treated pericardium for reconstruction of coronary button defects at the arterial switch operation (ASO). This may impact the incidence of pulmonary stenosis and prevent primary closure of the pericardium. We report a series where 2-ply extracellular matrix (Tyke) was used to reconstruct the neopulmonary root. Methods: Since May 2016, all patients (n = 38) were repaired using Tyke for reconstruction of the coronary button defects. We measured the incidence of pulmonary stenosis and insufficiency at the main pulmonary artery (MPA) and branch pulmonary arteries by echocardiogram and compared these measurements with the historical cohort where pericardium (some treated with glutaraldehyde, some fresh) was used. Results: Mean follow-up was 3.0 ± 2.4 years (range, 1 month to 8 years). The mean gradient at the neopulmonary valve was 6.8 ± 7 mm Hg in the Tyke group versus 23.7 ± 16.1 in the pericardium group ( P < .01). The mean gradient at the distal MPA was 8.9 ± 2.9 mm Hg for the Tyke group and 44.5 ± 40.1 in the historical group ( P < .01). The mean gradient at the proximal left and right branch pulmonary arteries was 29 ± 19 and 32 ± 16 mm Hg in the Tyke group and 33 ± 16 and 36 ± 26 (NSD). At the last follow-up, six of 38 patients (18%) in the Tyke group had a pulmonary reintervention: five patients had a balloon dilation of branch pulmonary arteries, and one patient had dilation of the MPA. No patients underwent surgical intervention on the pulmonary valve or the reconstructed MPA. Conclusion: Tyke is a reasonable alternative material for reconstruction of the coronary button defects during the ASO within the follow-up period.