Skip to main content
SpringerLink
Log in

Speckle Tracking in ALCAPA Patients After Surgical Repair as Predictor of Residual Coronary Disease

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Surgical re-implantation of the left coronary artery (LCA) is the treatment of choice in anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Despite normalization of left ventricular function after surgery, residual coronary lesions or myocardial fibrosis may be found. The aim of this study was to detect regional left ventricular dysfunction predictive of coronary lesions or residual myocardial fibrosis using speckle tracking. We enrolled ten patients treated with surgical re-implantation of LCA for ALCAPA. All patients were asymptomatic, and ejection fraction (EF) was normal. Using S-SR imaging, we studied longitudinal, radial, and circumferential function. A cardiac MRI was performed to assess myocardial fibrosis and the anatomy of the coronaries. In case of suspected coronary stenosis, a coronary angiography was performed. Finally, 20 normal subjects were enrolled as control group. Median age at surgery was 188 days, and mean follow-up was 8.7 ± 4.7 years. Longitudinal and circumferential functions were reduced in LCA territory compared to RCA territory and normal. MRI showed LCA stenosis in three of ten patients, confirmed by coronary angiography: these patients had the lowest longitudinal strain values in LCA territories (−11.7, −14.7 and −14.8%). Radial strain was preserved (Normal 45.6 ± 12.1, ALCAPA 43.5 ± 10.7%, p = ns), while circumferential strain was mildly depressed (−23.5 ± 3.8 vs. −20.3 ± 2.0%, p < 0.05). After LCA re-implantation, ALCAPA patients showed a residual sub-endocardial damage in LCA territories. Despite a normal systolic and diastolic function, the prevalence of residual coronary lesions was high. A mean longitudinal strain >−15% in LCA territories was able to identify those patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ALCAPA:

Anomalous origin of left coronary artery from the pulmonary artery

C-MRI:

Cardiac magnetic resonance imaging

IVRT:

Isovolumetric relaxation time

LCA:

Left coronary artery

LGE:

Late gadolinium enhancement

LV:

Left ventricle

RCA:

Right coronary artery

RV:

Right ventricle

S:

Strain

SR:

Strain rate

TDI:

Tissue Doppler imaging

References

  1. Cowies RA, Berdon WE (2007) Bland—White—Garland syndrome of anomalous left coronary artery arising from the pulmonary artery [ALPACA]: a historical review. Pediatr Radiol 37:890–895

    Article  Google Scholar 

  2. Dodge-Khatami A, Mavroudis C, Backer CL (2002) Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 74:946–955

    Article  PubMed  Google Scholar 

  3. Wesselhoeft H, Fawcett JS, Johnson AL (1968) Anomalous origin of the left coronary artery from the pulmonary trunk: its clinical spectrum, pathology, and pathophysiology, based on a review of 140 cases with seven further cases. Circulation 38:403–425

    Article  CAS  PubMed  Google Scholar 

  4. Shivalkar B, Borgers M, Daemen W, Gewillig M, Flameng W (1994) ALCAPA syndrome: an example of chronic myocardial hypoperfusion? J Am Coll Cardiol 23:772–778

    Article  CAS  PubMed  Google Scholar 

  5. Smith A, Arnold R, Anderson RH, Qureshi SA, Gertis LM, Mckay R. (1989) Anomalous origin of the left coronary artery from the pulmonary trunk: anatomic findings in relation to pathophysiology and surgical repair. J Thorac Cardiovasc Surg 98:16–24.

    CAS  PubMed  Google Scholar 

  6. Singh TP, Dicarli MF, Sullivan NM, Leonen MF, Morrow WR (1998) Myocardial flow reserve in long term survivors of repair of anomalous left coronary artery from pulmonary artery. J Am Coll Cardiol 31:437–443

    Article  CAS  PubMed  Google Scholar 

  7. Secinaro A, Ntsinjana H, Tann O et al (2001) Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection (ALCAPA). J Cardiovasc Magn Reson 13:27

    Article  Google Scholar 

  8. Latus H, Gummel K, Rupp S et al. (2014) Cardiovascular magnetic resonance assessment of ventricular function and myocardial scarring before and early after repair of anomalous left coronary artery from the pulmonary artery. J Carvasc Magn Reson 16:3

    Google Scholar 

  9. Di Salvo G, Pacileo G, Rea A et al (2005) Quantitative evaluation of regional myocardial function using strain and strain rate imaging: normal values in pediatric age. Ital Heart J 6:420–426

    Google Scholar 

  10. Di Salvo G, Pacileo G, Gala S et al (2006) Strain rate imaging: data acquisition and post processing. Minerva Cardioangiol 54:451–459

    CAS  PubMed  Google Scholar 

  11. Langeland S, D’hooge J, Wouters PF et al (2005) Experimental validation of a new ultrasound method for the simultaneous assessment of radial and longitudinal myocardial deformation independent of insonation angle. Circulation 112:2157–2162

    Article  PubMed  Google Scholar 

  12. Castaldi B, Santoro G, Di Salvo G et al (2013) Impact of the Amplatzer atrial septal occlude device on left ventricular function in pediatric patients. Pediatr Cardiol 34(7):1645–1651

    Article  PubMed  Google Scholar 

  13. Cabrera AG, Chen DW, Pignatelli RH et al (2015) Outcomes of anomalous left coronary artery from pulmonary artery repair: beyond normal function. Ann Thorac Surg 99(4):1342–1347

    Article  PubMed  Google Scholar 

  14. Fratz S, Hager A, Schreiber C, Schwaiger M, Hess J, Stern HC (2011) Long-term myocardial scarring after operation for anomalous left coronary artery from the pulmonary artery. Ann Thorac Surg 92(5):1761–1765

    Article  PubMed  Google Scholar 

  15. Shivalkar B, Borgers M, Daenen W, Gewillig M, Flameng W. (2009) ALCAPA syndrome: an example of chronic myocardial hypoperfusion? J Am Coll Cardiol 23(3): 772–778

    Article  Google Scholar 

  16. Bergmann O, Bhardwaj RD, Bernard S et al (2009) Evidence for cardiomyocyte renewal in humans. Science 324:98–102

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Schmitt B, Bauer S, Kutty S, Nordmeyer S, Nasseri B, Berger F, Alexi-Meskishvili V (2014) Myocardial perfusion, scarring, and function in anomalous left coronary artery from the pulmonary artery syndrome: a long-term analysis using magnetic resonance imaging. Ann Thorac Surg 98(4):1425–1436

    Article  PubMed  Google Scholar 

  18. Di Salvo G, Eyskens B, Claus P et al (2004) Late post-repair ventricular function in patients with origin of the left main coronary artery from the pulmonary trunk. Am J Cardiol 93:506–508

    Article  PubMed  Google Scholar 

  19. Nordgaard H, Swillens A, Nordhaug D et al (2010) Impact of competitive flow on wall shear stress in coronary surgery: computational fluid dynamics of a LIMA-LAD model. Cardiovasc Res 88(3):512–519

    Article  CAS  PubMed  Google Scholar 

  20. Neglia D, Rovai D, Caselli C et al. (2015) Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. Circ Cardiovasc Imaging 8(3):e002179

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, via Giustiniani 3, 35128, Padua, Italy

    Biagio Castaldi, Elena Reffo, Queenette Daniels & Ornella Milanesi

  2. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy

    Vladimiro Vida, Massimo Padalino & Giovanni Stellin

Authors
  1. Biagio Castaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vladimiro Vida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elena Reffo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Massimo Padalino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Queenette Daniels
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giovanni Stellin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ornella Milanesi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Biagio Castaldi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Castaldi, B., Vida, V., Reffo, E. et al. Speckle Tracking in ALCAPA Patients After Surgical Repair as Predictor of Residual Coronary Disease. Pediatr Cardiol 38, 794–800 (2017). https://doi.org/10.1007/s00246-017-1583-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-017-1583-z

Keywords

Search

Navigation