Myocardial function in patients with anomalous left coronary artery from the pulmonary artery syndrome: A long-term speckle tracking echocardiographic study

English version

Autoři: Alicja Dąbrowska-Kugacka ^aff001; Karolina Dorniak ^aff002; Jarosław Meyer-Szary ^aff003; Agnieszka Herrador Rey ^aff003; Ewa Lewicka ^aff001; Katarzyna Ostrowska ^aff004; Joanna Kwiatkowska ^aff003
Působiště autorů: Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland ^aff001; Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland ^aff002; Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdansk, Gdansk, Poland ^aff003; Department of Cardiology, Polish Mother’s Memorial Hospital–Research Institute, Lodz, Poland ^aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223227

Souhrn

Background

Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare congenital heart disease. Retrograde flow from the right coronary artery (RCA) through natural collaterals to the low-pressure main pulmonary artery causes extensive ischemia. Limited data concerning the extent of permanent myocardial damage and functional recovery after surgical repair in the long-term follow-up is available.

Aim

Determination of the incidence of incipient myocardial dysfunction in ALCAPA patients in the long-term observation using tissue Doppler and speckle tracking echocardiography.

Methods and results

Eighteen ALCAPA patients after surgical repair (at median age of 7 months, range 3–167) underwent echocardiographic examination after (median) 17 years. All but 4 patients in NYHA class II presented well at follow-up. No narrowing in proximal LCA was detected in color Doppler. The initial (pre-surgical) left ventricular (LV) ejection fraction of 33±17% almost normalized to 55±6%, but was lower than in the age, sex and body surface area matched control group: 62±5% (p<0.001). At follow-up, LV global longitudinal strain (LS): -15.8±3.3% vs -21.9±1.7%; right ventricular LS: -20.6±3.9% vs -24.9±4.6%; left atrial LS: 27.7±4.3% vs 41.0±11.5%; right atrial LS: 26.8±7.4% vs 44.0±7.9% and early pulsed wave to tissue Doppler mitral filling ratio (E/E’): 8.1±2.6 vs 5.8±1.3 were impaired in the ALCAPA population in comparison to the control group (p<0.01 for all comparisons). LV radial and circumferential strain did not differ between groups. Mean LS in the ALCAPA patients in the RCA region was -19.0±4.4%, while in the LCA region -13.8±7.3% (p<0.00001).

Conclusions

Despite good clinical condition and normalized LV ejection fraction in ALCAPA patients after surgical repair in the long-term follow-up, the diastolic and longitudinal systolic function of all cardiac chambers remained impaired, especially in the LCA region. Lifelong surveillance of repaired ALCAPA patients is needed.

Klíčová slova:

Surgical and invasive medical procedures – Coronary heart disease – Ischemia – Stenosis – Echocardiography – Pulmonary arteries – Surgical repair – Papillary muscles

Zdroje

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