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Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection (ALCAPA)

Secinaro, A; Ntsinjana, H; Tann, O; Schuler, PK; Muthurangu, V; Hughes, M; ... Taylor, AM; + view all (2011) Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection (ALCAPA). Journal of Cardiovascular Magnetic Resonance , 13 , Article 27. 10.1186/1532-429X-13-27. Green and gold open access

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Abstract

Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly. This study shows the role of cardiovascular magnetic resonance (CMR) in assessing young patients following surgical repair of ALCAPA.Methods: 6 patients, aged 9-21 years, with repaired ALCAPA (2 Tackeuchi method, 4 direct re-implantation) underwent CMR because of clinical suspicion of myocardial ischemia. Imaging used short and long axis cine images (assess ventricular function), late-gadolinium enhancement (LGE) (detect segmental myocardial fibrosis), adenosine stress perfusion (detect reversible ischaemia) and 3D whole-heart imaging (visualize proximal coronary arteries).Results: The left ventricular (LV) global systolic function was preserved in all patients (mean LV ejection fraction = 62.7% +/- 4.23%). The LV volumes were within the normal ranges, (mean indexed LVEDV = 75.4 +/- 3.5 ml/m(2), LVESV = 31.6 +/- 9.4 ml/m(2)). In 1 patient, hypokinesia of the anterior segments was visualized. Five patients showed subendocardial LGE involving the basal, antero-lateral wall and the anterior papillary muscle. Three patients had areas of reversible ischemia. In these 3, 3D whole-heart MRA showed that the proximal course of the left coronary artery was occluded (confirmed with cardiac catheterisation).Conclusions: CMR is a good, non-invasive, radiation-free investigation in the post-surgical evaluation of ALCAPA. In referred patients we show that basal, antero-lateral sub-endocardial myocardial fibrosis is a characteristic finding. Furthermore, stress adenosine CMR perfusion, can identify reversible ischemia in this group, and was indicative of left coronary artery occlusion.

Type:Article
Title:Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection (ALCAPA)
Open access status:An open access publication. A version is also available from UCL Discovery.
DOI:10.1186/1532-429X-13-27
Publisher version:http://dx.doi.org/10.1186/1532-429X-13-27
Language:English
Additional information:© 2011 Secinaro et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords:ANGIOGRAPHY, CHILDREN, ORIGIN, DISEASE, THERAPY, INFANTS, HEART
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science

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