MP37. Mitral Valve Repair in Reintervention of Anomalous Origin of The Left Coronary Artery from the Pulmonary Artery in a Young Patient

New York Hilton Midtown 

Introduction: ALCAPA is a rare coronary alteration that can present itself in a unique clinical sense (0.25%)with a high mortality rate during the first year of life. Surgical correction is the best treatment to manage this condition. In this case report, we'll present a patient that during his first year of life, went through a correction and throughout his adolescence, started suffering congestive heart failure thanks to mitral valve regurgitation.Case Report: A 20-year-old male patient was treated that while he was 11 months old was intervened .On this opportunity, he underwent a corrective surgery using the Takeuchi procedure (figure 1). 20 years later he found himself getting diagnosed with cardiomegaly at the expense of the left chambers after a global cardiac insufficiency (class IV/NYHA) was detected. On an echocardiogram, a dilatation of every single left chamber was discovered, with a severe mitral regurgitation and global hypokinesia predominantly in the anterior wall of the left ventricle (figure 2). Through a coronary angiography it was later on revealed that the transpulmonary patch was dehiscent and was causing the left coronary flow to direct itself to the pulmonary artery with a valve regurgitation, producing an important pulmonary hypertension (figure 3).Procedure: The reintervention was done through a sternotomy and central cannulation, using cold blood cardioplegia. The pulmonary opening was made and the total dehiscence of the pulmonary patch was verified (figure 4). Subsequently, a neoduct with pericardium and the suspension of the cuspids of the pulmonary artery took place until a coadaptation was achieved (figure 5). Next up, an exploration of the of the mitral valve through the left atrium was made and dilatation annulus was found. It was repaired with the placement of a semi-rigid mitral ring (Carpentier N° 32) (figure 6). The patient was leaves with an echocardiogram with a correct dynamic and normal functioning (figure 7) For the 14 years to come, the patient has maintained himself asymptomatic with a normal cardiac function with no evidence of any sort of ventricular dysfunction and repair without mitral valve regurgitation. Summary:ALCAPA it's a rare congenital anomaly that it ought to be corrected surgically immediately. In this case, heart failure due to mitral valve dysfunction. The choosing of the correct surgical technique along with the experience with these types of cases in adults is to obtain satisfying results.