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Category: Volume 07 Issue 04 April 2019
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Title: Management of mitral valve regurgitation in patients with ALCAPA

Authors: Dr Tasneem Muzaffar, Dr Nasir U Din Wani, Dr Syed Abir Hussain, Dr Tufela Shafi, Dr Sunil GS

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.162

Abstract

Introduction: Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation. Immediate surgical correction on diagnosis with the aim of restoring a two-coronary system circulation is the current standard of treatment. However, the management of the mitral valve regurgitation in these patients is controversial.

Methods: Fifty one patients of ALCAPA underwent coronary reimplantation over a 10-year period. The mitral valve was not addressed (except one patient with an organic basis) at the time of coronary implantation even in patients with moderate to severe mitral regurgitation. These patients were followed postoperatively with with serial echocardiography at six months and at two years thereafter to assess the improvement in ventricular and mitral valvular function.

Result: A total of 53 cases were studied. Mitral valve regurgitation of varying severity was seen in 51 (96.5%) of the 53 patients preoperatively. There were 5 postoperative deaths (9.6%). Postoperatively, after 6 months, mitral regurgitation was none to mild in 38 patients (84.4%, n= 45). Moderate to severe mitral regurgitation was seen in 7 patients (15.6%). At 2 years follow up, 43 patients (95.5%, n= 45) had none to mild mitral regurgitation. Only two patients had moderate to severe mitral regurgitation.

Conclusion: Reimplantation of anomalous coronary artery to the aorta must be the procedure of choice in patients with ALCAPA. Mitral valve repair is not required even in severe regurgitation, except when there is an organic basis of regurgitation.

Keywords: ALCAPA, mitral regurgitation, coronary reimplantation.

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Corresponding Author

Dr Tasneem Muzaffar

Consultant CVTS, GMC, Srinagar