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Speckle Tracking in ALCAPA Patients After Surgical Repair as Predictor of Residual Coronary Disease
- Source :
- Pediatric cardiology. 38(4)
- Publication Year :
- 2016
-
Abstract
- Surgical re-implantation of the left coronary artery (LCA) is the treatment of choice in anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Despite normalization of left ventricular function after surgery, residual coronary lesions or myocardial fibrosis may be found. The aim of this study was to detect regional left ventricular dysfunction predictive of coronary lesions or residual myocardial fibrosis using speckle tracking. We enrolled ten patients treated with surgical re-implantation of LCA for ALCAPA. All patients were asymptomatic, and ejection fraction (EF) was normal. Using S-SR imaging, we studied longitudinal, radial, and circumferential function. A cardiac MRI was performed to assess myocardial fibrosis and the anatomy of the coronaries. In case of suspected coronary stenosis, a coronary angiography was performed. Finally, 20 normal subjects were enrolled as control group. Median age at surgery was 188 days, and mean follow-up was 8.7 ± 4.7 years. Longitudinal and circumferential functions were reduced in LCA territory compared to RCA territory and normal. MRI showed LCA stenosis in three of ten patients, confirmed by coronary angiography: these patients had the lowest longitudinal strain values in LCA territories (-11.7, -14.7 and -14.8%). Radial strain was preserved (Normal 45.6 ± 12.1, ALCAPA 43.5 ± 10.7%, p = ns), while circumferential strain was mildly depressed (-23.5 ± 3.8 vs. -20.3 ± 2.0%, p 0.05). After LCA re-implantation, ALCAPA patients showed a residual sub-endocardial damage in LCA territories. Despite a normal systolic and diastolic function, the prevalence of residual coronary lesions was high. A mean longitudinal strain-15% in LCA territories was able to identify those patients.
- Subjects :
- medicine.medical_specialty
Coronary Artery Disease
030204 cardiovascular system & hematology
Phantoms imaging
Asymptomatic
Pediatrics
030218 nuclear medicine & medical imaging
03 medical and health sciences
Ventricular Dysfunction, Left
0302 clinical medicine
Left coronary artery
medicine.artery
Internal medicine
Bland White Garland Syndrome
medicine
Humans
Child
Ejection fraction
Bland white garland syndrome
Myocardium
Thoracic surgical procedures
Pediatrics, Perinatology and Child Health
Cardiology and Cardiovascular Medicine
business.industry
Infant
Vascular surgery
Perinatology and Child Health
medicine.disease
Coronary Vessels
Fibrosis
Magnetic Resonance Imaging
Cardiac surgery
Stenosis
Echocardiography
Child, Preschool
Pulmonary artery
Cardiology
Myocardial fibrosis
Radiology
medicine.symptom
business
Vascular Surgical Procedures
Subjects
Details
- ISSN :
- 14321971
- Volume :
- 38
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Pediatric cardiology
- Accession number :
- edsair.doi.dedup.....23c480567c11f4d1878540f127e48348