Sekelyk R. Improvement of diagnostic and surgical treatment of anomalous origin of coronary arteries from pulmonary artery.

This is the first study in Ukraine that devoted to the problem of anomalous pulmonary origins of the coronaries (APOC) repair. In this study, we analyzed our clinical experience of diagnostics and surgical treatment of APOC . Our study group included 46 patients, who have been operated on from may 2003 till november 2014. Diagnostic data analysis revealed considerable percentage of misdiagnoses, which were set in patients with APOC in regional hospitals. Nevertheless, in recent years, an increase in correctly diagnosed and surgically treated patients with APOC can be observed due to diagnostic algorithms we have developed. In our study we evaluated a method of coronary artery reimplantation in surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). We demonstrated that reimplantation of the left coronary artery into the aorta is the effective method of surgical treatment of ALCAPA. In the late postoperative period we can see a statistically significant increase in the left ventricle ejection fraction (LVEF) and decrease of the left ventricle end-diastolic index (LVEDI), compared to preoperative values (р<0,05). Also it has been shown that utilization of the custom-made non-officinal cardioplegic solution for a myocardial protection is a statistically significant factor of hospital mortality in patients with ALCAPA (p=0,003) and significant factors for postoperative morbidity are body weight, LVEF and LVEDI (р<0,05). Patients with body weight less than 6.3 kg, LVEF < 40% and LVEDI > 150 ml/m2 are in an increased risk for postoperative morbidity. Our improved method of coronary artery elongation is the technique of choice in surgical treatment of complex anatomic forms of ALCAPA. We had no postoperative mortality and morbidity, utilizing this surgical technique.