การเกิดหลอดเลือดแดงโคโรนารีซ้ายออกจากหลอดเลือดแดงปอดในผู้ป่วยเด็ก: การศึกษาย้อนหลัง 20 ปี ณ ศูนย์หัวใจสิริกิติ์ มหาวิทยาลัยขอนแก่น ประเทศไทย

Vanida Bounthavy; Sourideth Sengchanh; Alongkone Phengsavan; Mick Soukavong; Seehapong Petcharat

Authors

Vanida Bounthavy Department of pediatrics, University of health sciences, Lao P.D.R
Sourideth Sengchanh Faculty of Medicine, University of Health Sciences, Lao PDR
Alongkone Phengsavan Faculty of Medicine, University of Health Sciences, Lao PDR
Mick Soukavong University of Health Sciences, Lao PDR
Seehapong Petcharat Faculty of Medicine, Khon Kaen University

Keywords:

ALCAPA, left ventricular systolic function, long-term outcome

Abstract

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary artery anomaly in pediatric patients. Despite its rarity, ALCAPA can be life-threatening and may result in left ventricular dysfunction and mitral regurgitation. If not treated promptly, death often occurs in infancy. This study aimed to retrospectively review and analyze the medical records of 15 pediatric patients diagnosed with ALCAPA who underwent surgical correction at the Queen Sirikit Heart Center of the Northeast between January 2004 and September 2024.

Results: Research findings from a study of 15 patients presented with a diagnosis between the ages of 2–192 months (median of 7 months). The majority were female (66.7%). The most common conditions were congenital mitral regurgitation (100%) and heart failure (73.3%). Electrocardiographic findings showed left ventricular enlargement in 93.3% and anterolateral myocardial infarction in 73.3%. Most patients (93.3%) underwent direct reimplantation of the coronary artery, with concomitant mitral valve repair performed in 33.3% of cases. The early postoperative mortality rate was 33.3%, primarily associated with severe preoperative left ventricular dysfunction and significant mitral regurgitation. Among survivors, 67.1% demonstrated marked improvement in left ventricular function. Follow-up over an average of 10 years showed that 10 patients improved to a New York Heart Association (NYHA) Class I level, and only 1 patient was at Class II.

Conclusion: Early surgical correction of ALCAPA improves long-term survival. However, patients presenting with severe preoperative left ventricular dysfunction and significant mitral regurgitation remain at higher risk for mortality.

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