Cor Vasa 2022, 64(6):677-679 | DOI: 10.33678/cor.2022.084

Successful Repair of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) using Pericardial Roll Graft: Case Report with Long-Term Follow-up

Dicky Fakhri^a, Putu Wisnu Arya Wardana^b, Abdurrahman Hadi^b, Pribadi W. Busro^a, Poppy S. Roebiono^{c, d}, Eva M. Marwali^e

^a Pediatric and Congenital Heart Surgery Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia

^b Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

^c Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia

^d Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

^e Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia

Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect that has serious challenges from diagnostic, surgical, to postoperative management. Case description: We report a 16-month-old patient, who underwent ALCAPA repair in our center. This patient came to the hospital with severe heart failure symptoms such as shortness of breath, cough and failure to thrive. Decreased left ventricle function and severe mitral valve regurgitation due to left ventricle dilatation was found. In this case, the left main artery (LMA) was not found and there were two ostial of the left anterior descending artery and circumflex artery on the pulmonary artery; we managed the coronary artery transfer by using 4-mm pericardial roll extension. No mechanical assist device was needed. Long-term follow-up of the patient (7 years) showed that the patient survived and had a class I Ross Heart Failure Classification. Follow-up echocardiography revealed improvement of left ventricular ejection fraction and mitral valve regurgitation.

Conclusion: ALCAPA repair is still a challenging procedure but has an excellent opportunity to improve the quality of life of the patient. Pericardial roll graft could be an optional procedure for ALCAPA repair to restore the dual coronary artery system.

Keywords: Anomalous origin of the left coronary artery from the pulmonary artery, Case report, Congenital heart disease, Long-term follow-up

Received: June 28, 2022; Revised: June 28, 2022; Accepted: July 23, 2022; Published: December 15, 2022  Show citation