Improvement in left ventricular dysfunction after aortic reimplantation in 11 consecutive paediatric patients with anomalous origin of the left coronary artery from the pulmonary artery

To study the potential for recovery of left ventricular function in patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) after aortic reimplantation, serial two-dimensional echocardiographic examinations were performed before and up to 9 months after operation in 11 consecutive paediatric patients (group 1: six infants; group 2: five children above the age of 1 year). End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), myocardial volume (MV), ratio of myocardial volume!end-diastolic volume (MVI), and regional wall motion of the left ventricle (LV) were studied. Pre-operativety, mean LVEDV was 339% of normal in group 1 and 289% in group 2 (P<0.001); mean LVMV was about twice the normal value in both groups (P<0.001); LVMVI was 0–79 ± 0–23 in group 1 and 0–83 ± 0–3 in group 2; LVEF was 28 ± 10% in group 1 and 46 ± 18% in group 2; regional wall motion was normal in two group 2 patients, the other showed uniform reduction in segmental shortening fraction. Postoperatively, mean LVEDV tended to become normal after 2 weeks in group 1 and after 3 months in group 2. In both groups mean LVEF reached the normal range after 3 months; LVMV as well as LVMVI normalized after 9 months. Three months after the operation, all infants had a nearly normal pattern of regional wall motion, while in three group 2 children a residual reduced shortening fraction could be observed in anterior or lateral segments. The study shows that (1) aortic reimplantation in patients with ALCAPA results in progressive improvement left ventricular function even in patients with severely damaged myocardium. (2) For a quick and complete recovery of global and regional left ventricular function, the operation should be undertaken early in infancy. (3) Left ventricular dysfunction is probably associated with ‘hibernating myocardium’, which may ‘wake up’ after surgical repair.