Cardiovascular magnetic resonance assessment of ventricular function and myocardial scarring before and early after repair of anomalous left coronary artery from the pulmonary artery

Journal of Cardiovascular Magnetic Resonance

Christian Apitz²  Dietmar Schranz²  Juergen Bauer²  Hakan Akintuerk¹  Gunter Kerst²  Christian Jux⁴  Matthias Mueller²  Stefan Rupp²  Kerstin Gummel²  Heiner Latus³ 

[1]Division of Pediatric Cardiovascular Surgery, University Children’s Hospital, Giessen, Germany

[2]Pediatric Heart Center, University Children’s Hospital, Giessen, Germany

[3]Pediatric Heart Center, Justus-Liebig-University of Giessen, Feulgenstr. 12, D-35392 Giessen, Germany

[4]Department of Pediatric Cardiology, University Children’s Hospital Münster, Münster, Germany

关键词: Infarction;    Hibernation;    Cardiovascular magnetic resonance;    Left ventricular remodelling;    ALCAPA syndrome;   

Others  :  801980
DOI  :  10.1186/1532-429X-16-3

 received in 2013-09-21, accepted in 2013-12-27,  发布年份 2014

【 摘 要 】

Background

In patients with anomalous left coronary artery from the pulmonary artery (ALCAPA) left ventricular (LV) dilatation and dysfunction evolves due to diminished myocardial perfusion caused by coronary steal phenomenon. Using late gadolinium enhanced cardiovascular magnetic resonance (LGE-CMR) imaging, myocardial scarring has been shown in ALCAPA patients late after repair, however the incidence of scarring before surgery and its impact on postoperative course after surgical repair remained unknown.

Methods

8 ALCAPA-patients (mean age 10.0 ± 5.8 months) underwent CMR before and early after (mean 4.9 ± 2.5 months) coronary reimplantation procedures. CMR included functional analysis and LGE for detection of myocardial scars.

Results

LV dilatation (mean LVEDVI 171 ± 94 ml/m²) and dysfunction (mean LV-EF 22 ± 10 %) was present in all patients and improved significantly after surgery (mean LVEDV 68 ± 42 ml/m², p = 0.02; mean LV-EF 58 ± 19 %, p < 0.001). Preoperative CMR revealed myocardial scarring in 2 of the 8 patients and did not predict postoperative course. At follow-up CMR, one LGE-positive patient showed delayed recovery of LV function while myocardial scarring was still present in both patients. In two patients new-onset transmural scarring was found, although functional recovery after operation was sufficient. One of them showed a stenosis of the left coronary artery and required resurgery.

Conclusions

Despite diminished myocardial perfusion and severely compromised LV function, myocardial scarring was preoperatively only infrequently present. Improvement of myocardial function was independent of new-onset scarring while the impact of preoperative scarring still needs to be defined.

【 授权许可】

   
2014 Latus et al.; licensee BioMed Central Ltd.

【 图 表 】

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