Diagnosis Modalities and Repair Techniques of Anomalous Origin of The Left Coronary Artery From The Pulmonary Artery Without Mechanical-assisted Device: Single-centre Experience

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital heart defect, which has serious challenges from diagnostic to surgical to postoperative management. Between August 2015 and February 2017, four patients, aged 5-16 months, underwent coronary reimplantations at the National Cardiovascular Center Harapan Kita Hospital, Jakarta. The patients arrived at the hospital with dyspnoea, cough, and failure to thrive. Decreased left ventricle functions were remarkably visible from the echocardiography in all cases. There was moderate-to-severe mitral valve regurgitation due to left ventricle dilatation. The diagnoses were confirmed by echocardiography in two cases, one case needed multislice computer tomography confirmation, and the other needed cardiac catheterisation confirmation. Different techniques were used in each patient; three patients had left coronary artery transfer directly to the aorta. In one patient, left main artery was not found, therefore the coronary artery was transferred by pericardial roll extension. Cardioplegia administration techniques were different in one patient. Directly after aortotomy, additional antegrade cardioplegia solution was delivered using an olive-tipped catheter to the left coronary artery, whereas the others relied solely on aortic root cardioplegic administration. All cases demonstrated successful outcome. No mechanical-assisted device was needed, and no mortality or morbidity was reported. Mean intensive care unit stay and mean postoperation hospital stay were 8 days and 16 days, respectively.