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Anomalous left coronary artery from the pulmonary artery (ALCAPA) as a concealed cause of severe mitral regurgitation in children and adults: Case reports.

ABSTRACT: INTRODUCTION:Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary artery anomaly and is a concealed cause of mitral regurgitation. PRESENTATION OF CASE:We reported two cases of severe mitral regurgitation in whom the presence of ALCAPA was overlooked in the first cardiac surgery. In the first case, ALCAPA was diagnosed one year after the mitral annuloplasty and the surgical reimplantation was successfully performed. In the second case, ALCAPA was incidentally detected on multislice computerized tomography during preoperative workup for the second surgery to replace the dehiscent mitral prosthesis. DISCUSSION:The clinical presentation of ALCAPA varies highly. It is not difficult to diagnose an ALCAPA in newborns and infants. Contrarily, ALCAPA in children and adults can be overlooked. CONCLUSION:Physicians should always look for the presence of ALCAPA in patients who present with unexplained mitral regurgitation. The surgical strategy in patients with ALCAPA should be carefully individualised to achieve an optimal outcome and alleviate complications.

SUBMITTER: Nguyen BH

PROVIDER: S-EPMC7508687 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Anomalous left coronary artery from the pulmonary artery (ALCAPA) as a concealed cause of severe mitral regurgitation in children and adults: Case reports.

Nguyen Bac Hoang BH Cao Khang Dang KD Thao Pham Thi Hieu PTH Vo Anh Tuan AT Le Khoi Minh KM

International journal of surgery case reports 20200911

<h4>Introduction</h4>Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary artery anomaly and is a concealed cause of mitral regurgitation.<h4>Presentation of case</h4>We reported two cases of severe mitral regurgitation in whom the presence of ALCAPA was overlooked in the first cardiac surgery. In the first case, ALCAPA was diagnosed one year after the mitral annuloplasty and the surgical reimplantation was successfully performed. In the s ...[more]

PMID: 32950944

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Project description:ObjectiveThe Cardiothoracic Surgical Trials Network reported that left ventricular reverse remodeling at 2 years did not differ between patients with moderate ischemic mitral regurgitation randomized to coronary artery bypass grafting plus mitral valve repair (n = 150) or coronary artery bypass grafting alone (n = 151). To address health resource use implications, we compared costs and quality-adjusted survival.MethodsWe used individual patient data from the Cardiothoracic Surgical Trials Network trial on survival, hospitalizations, quality of life, and US hospitalization costs to estimate cumulative costs and quality-adjusted life years. A microsimulation model was developed to extrapolate to 10 years. Bootstrap and deterministic sensitivity analyses were performed to address uncertainty.ResultsIn-hospital costs were $59,745 for coronary artery bypass grafting plus mitral valve repair versus $51,326 for coronary artery bypass grafting alone (difference $8419; 95% uncertainty interval, 2259-18,757). Two-year costs were $81,263 versus $67,341 (difference 13,922 [2370 to 28,888]), and quality-adjusted life years were 1.35 versus 1.30 (difference 0.05; -0.04 to 0.14), resulting in an incremental cost-effectiveness ratio of $308,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ($107,733 vs $88,583, difference 19,150 [-3866 to 56,826]) and quality-adjusted life years showed no difference (-0.92 to 0.87), with 5.08 versus 5.08. The likelihood that coronary artery bypass grafting plus mitral valve repair would be considered cost-effective at 10 years based on a cost-effectiveness threshold of $100K/quality-adjusted life year did not exceed 37%. Only when this procedure reduces the death rate by a relative 5% will the incremental cost-effectiveness ratio fall below $100K/quality-adjusted life year.ConclusionsThe addition of mitral valve repair to coronary artery bypass grafting for patients with moderate ischemic mitral regurgitation is unlikely to be cost-effective. Only if late mortality benefits can be demonstrated will it meet commonly used cost-effectiveness criteria.

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Anomalous left coronary artery from the pulmonary artery (ALCAPA) as a concealed cause of severe mitral regurgitation in children and adults: Case reports.

Publications

Anomalous left coronary artery from the pulmonary artery (ALCAPA) as a concealed cause of severe mitral regurgitation in children and adults: Case reports.

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