Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Ischemic left ventricular remodeling in anomalous origin of the left coronary artery from the pulmonary trunk

Authors: T.V. Rogova, L.A. Boсkeria, I.P. Aslanidis

Company:
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

Link: Clinical Physiology of Blood Circulaiton. 2013; (): -

Download
Full text:  

Abstract

Objective. Study of the causes and extent of ischemic left ventricular remodeling in the anomalous discharge of the left coronary artery in different types of the disease, its effect on the severity of heart failure and results of surgical treatment.

Material and methods. We examined 111 patients with ALCAPA. The age groups considered: I < 1 year; II – between 1 and 3 years; III > 3 years. Echocardiography, ECG studies performed in all patients, Holter monitoring conducted 26 patients (21 patients I group), angiographic study of 92 patients (I group – 39 patients, II – 13 patients, III – 40 patients), radionuclide diagnostics methods – 60 patients (I group – 37 patients, III – 23). Statistical data processing was performed with the use of programs such as Microsoft Excel 2000 and Statistica 6.0 (Stat-Soft, 2001).

Results. According to the data of clinical and instrumental examination, the highest degree of ischemic LV remodeling was defined in the first age group. Weak intercoronary collateral vessels determines the large myocardial ischemic injury of LV (25.24±10.34%), which determines the severity of LV remodeling LVDI > 200 ml/m2, sharp decrease in contractility, increase of dysfunctional segments number. The large size of the left ventricle into the became a risk factor for congestive heart failure, arrhythmias, cardio shock. Patients with increase of LVDI > 150 ml/m2, EF < 35% constituted the group of the high surgical risk.

Conclusions. A large part of the affected myocardium ischemia is in a state of hibernation and could recover after reperfusion. This makes to look for methods of pre-, intra- and postoperative treatment, which could be an alternative to heart transplantation.

References

1. Бокерия Л.А., Гудкова Р.Г. Болезни и врожденные аномалии системы кровообращения. М.: НЦССХ им. А.Н. Бакулева РАМН; 2004. 2. Бокерия Л.А., Можина А.А., Роева Л.А., Федоров Г.Г. Геометрия левого желудочка и ее значение в патогенезе нарушений гемодинамики при постинфарктной аневризме сердца. Патол. кровообращения и кардиохирургия. 1998; 273: 51–3. 3. White H.D., Norris R.M., Brown M.A. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation. 1987; 76: 44–51. 4. Shivalkar B., Borges M., Daenen W., Gewillig M., Flameng W. ALCAPA syndrome: an example of chronic myocardial hypoperfusion. J. Am. Coll. Cardiol. 1994; 23: 772–8. 5. Karolczak M.A., Wieteska J., Bec L., Madry W. Anomalous origin of the left coronary artery (LCA) from pulmonary trunk (Bland–White–Garland syndrome) with systemic collateral supply to LCA. Med. Sci. Monit. 2001; 7: 755–8. 6. Рогова Т.В., Иванова О.И., Донцова В.И., Ремезова Т.С., Владимирская М.А., Барышникова И.Ю. Функциональное состояние миокарда левого желудочка у детей после оперативного лечения коарктации аорты в грудном возрасте. Детские болезни сердца и сосудов. 2010; 2: 31–4. 7. Olivetti G., Capasso J., Sonnenblick E., Anversa P. Side-to-side slippage of myocites partipates in ventricular wall remodeling acute after myocardial infarction in rats. Circ. Res. 1990; 67: 23–34. 8. Бокерия Л.А., Шаталов К.В., Арнаутова И.В. Аномальное отхождение левой коронарной артерии от легочной артерии. М.: НЦССХ им. А.Н. Бакулева РАМН; 2010. 9. Dambrink J.H., Sippens-Groenwegen A., van Gilst W.H., Peels K.H. Association of left ventricular remodeling and nonuniform electrical recovery expressed by nondipolar QRST integral map patterns in survivors of a first anterior myocardial infarction. Captopril and Thrombolysis Study Investigtors. Circulation. 1995; 92 (3): 300–10. 10. Frapier J.M., Leclercq F., Bodino M., Chaptal P.A. Malignant ventricular arrhythmias revealing anomalous origin of the left coronary artery from the pulmonary artery in two adults. Eur. J. Cardiothorac. Surg. 1999; 15: 539–41. 11. Wesselhoeft H., Fawcett J.S., Johnson A.L. 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. 1968; 38: 403–25. 12. Haas F., Jannen L., Heinzmann U. Ischemically compromised myocardium displays different time-sourss of functional recovery: correlation with morphological alternation? Eur. J. Cardiothorac. Surg. 2001; 20: 290–1. 13. Бокерия Л.А., Асланиди И.П., Вахромеева М.Н., Кацитадзе З.Д., Беришвили И.И. Возможности сцинтиграфии миокарда с 201Tl при аномальном отхождении коронарных артерий от легочной артерии. Грудная и сердечно-сосудистая хирургия. 1999; 4: 21–7. 14. Miyamoto T., Horigome H., Sato H. et al. Anomalous origin of the left coronary artery from the pulmonary trunk with myocardial infarction and severe left ventricular dysfunction in infancy – assessment of myocardial damage using SPECT studies with 201TlCl and 123I-BMIPP. Circulation. 1996; 33 (2): 169–74. 15. Yamagishi M., Shuntoh K., Shinkawa T., Hisaoka T., Ogawa M., Kohshi K. et al. Partial left ventriculectomy for infantile ischemic cardiomyopathy caused by anomalous origin of the left coronary artery from the pulmonary artery. J. Thorac. Cardiovasc. Surg. 2005; 130: 897–9. 16. Бокерия Л.А., Голухова Е.З., Еремеева М.В. и др. Новые подходы к лечению ишемической болезни сердца: терапевтический ангиогенез в сочетании с хирургической реваскуляризацией миокарда. Терапевтический архив. 2004; 76 (6): 25–30. 17. Eremeeva M.V., Golukhova E.Z., Bockeria L.A. Endogenous angiogenesis activation in ischemic heart disease patient: different methods of myocardial revascularization of strategies for therapeutic angiogenesis. In: Angiogenesis, bench to bedside. Medical and Engineering Publishers, Inc.; 2003: 275–92. 18. Friedberg M.K., Mertens L. Tissue velocities, strain, and strain rate for echocardiographic assessment of ventricular function in congenital heart disease. Eur. J. Echocard. 2009; 10: 585–93. 19. Gunaydin S., Gokgoz L., Unlu M. et al. Bland–White–Garland syndrome in an adalt. Case report and review of diagnostic and predictive strategies. Scand. Cardiovasc. J. 1997; 31 (2): 105–9. 20. McDonald K.M., Mock J., D’Aloia A. et al. Bradykinin antagonism inhibits the antigrowth effect of converting enzyme inhibition in the dog myocardium after discrete transmural myocardial necrosis. Circulation. 1995; 91 (7): 2043–8. 21. Sutton M. St. J. Quantitative 2D echocardiography is major prognostic factor for survival following myocardial infarction. Circulation. 1991; 84 (2): 11–6. 22. Rahimtoola S.H., Dilsizian V., Kramer C.M. et al. Chronic ischemic left ventricular dysfunction: from pathophysiology to imaging and its integration into clinical practice. J. Am. Coll. Cardiol. Cardiovasc. Imag. 2008; 7: 536–55. 23. Brown J.W., Ruzmetov M., Parent J., Rodefeld M., Turrentine M. Does the degree of preoperative mitral regurgitation predict survival or the need for mitral valve repair or replacement in patients with anomalous origin of the left coronary artery from the pulmonary artery? J. Thorac. Cardiovasc. Surg. 2008; 136: 743–8. 18

 If you found mistakes, select text and press Alt+A