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• W2091250992 abstract "Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) can sometimes be diagnosed very early in newborns and thus be corrected surgically before any myocardial ischaemia occurs. To evaluate the influence of this very early surgery on intensive care management and long-term outcome. All children operated on for ALCAPA before the age of 1 year between 1995 and 2010 were considered. Those operated on before the onset of ischaemia (group B) were compared with a matched group of children of similar weight who were operated on by the same surgeon on a close surgery date (group A). We obtained a homogenous population of 13 children (eight in group A; five in group B) with no significant weight difference between groups. The surgical technique and peroperative variables were similar in both groups. There was one death in each group. The group B death was due to postoperative occurrence of global myocardial infarction despite correct surgical reparation. Mechanical ventilation duration, inotropic support duration, intensive care duration and long-term complications were lower in group B. Very early ALCAPA surgical correction before occurrence of ischaemia must be encouraged whenever possible because it simplifies intensive care management and prevents persistent mitral regurgitation, but it does not reduce peroperative risk. Il est parfois possible de dépister une coronaire gauche naissant anormalement du tronc pulmonaire (Alcapa) à un très jeune âge et donc de corriger chirurgicalement cette anomalie avant la survenue de l’ischémie. Évaluer l’influence d’une telle chirurgie précoce sur la réanimation et le devenir à long terme. Tous les enfants opérés d’une Alcapa avant l’âge d’un an entre 1995 et 2010 dans nos deux centres ont été inclus. Ceux opérés avant l’ischémie constituée (groupe B) ont été comparés à un groupe témoin (groupe A) appareillé sur le poids, la date opératoire et le chirurgien. Nous avons constitué une population homogène de 13 patients (huit dans le groupe A et cinq dans le groupe B). Le poids, la technique chirurgicale et les paramètres peropératoires étaient similaires dans les deux groupes. Il y a eu un mort dans chaque groupe. Le décès du groupe B a été imputé à la survenue d’un infarctus massif au décours immédiat de la chirurgie malgré une réparation correcte. Pour autant, la durée de ventilation, du support inotrope et du séjour en réanimation ainsi que les complications à long terme ont été moins importantes dans le groupe B. La réparation très précoce des Alcapa avant constitution de l’infarctus doit être choisie dès que possible car la réanimation s’en trouve simplifiée et les régurgitations mitrales persistantes moins fréquentes. Cependant, ce choix ne diminue pas le risque opératoire." @default.
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• W2091250992 date "2010-11-01" @default.
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• W2091250992 title "Very early correction of anomalous left coronary artery from the pulmonary artery improves intensive care management" @default.
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• W2091250992 doi "https://doi.org/10.1016/j.acvd.2010.10.005" @default.
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