Very early correction of anomalous left coronary artery from the pulmonary artery improves intensive care management.

Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) can sometimes be diagnosed very early in newborns and thus be corrected surgically before any myocardial ischaemia occurs.

Aim: To evaluate the influence of this very early surgery on intensive care management and long-term outcome.

Methods: All children operated on for ALCAPA before the age of 1 year between 1995 and 2010 were considered. Those operated on before the onset of ischaemia (group B) were compared with a matched group of children of similar weight who were operated on by the same surgeon on a close surgery date (group A).

Results: We obtained a homogenous population of 13 children (eight in group A; five in group B) with no significant weight difference between groups. The surgical technique and peroperative variables were similar in both groups. There was one death in each group. The group B death was due to postoperative occurrence of global myocardial infarction despite correct surgical reparation. Mechanical ventilation duration, inotropic support duration, intensive care duration and long-term complications were lower in group B.

Conclusion: Very early ALCAPA surgical correction before occurrence of ischaemia must be encouraged whenever possible because it simplifies intensive care management and prevents persistent mitral regurgitation, but it does not reduce peroperative risk.