Analysis of the Takeuchi procedure for the treatment of anomalous origin of the left coronary artery from the pulmonary artery

Abstract

Background: Evaluation of a case series of anomalous origin of the left coronary artery from the pulmonary artery corrected with the Takeuchi procedure, analyzing their immediate and late surgical outcomes as well as the related morbidity.

Objective: To report a case series of anomalous origin of the left coronary artery from the pulmonary artery corrected with the Takeuchi procedure.

Methods: The analysis was based on data collected from the medical records of 12 patients undergoing surgical correction between 1981 and 2003.

Results: The mean age of the patients was 5.9 +/- 1.7 months. The predominant manifestation was heart failure, especially in the infants. The baseline electrocardiogram showed a Q wave in DI and aVL and signs of myocardial ischemia in ten cases. Echocardiogram with a pattern of dilated cardiomyopathy and mitral regurgitation was found in six patients. The mean age at surgical correction was 31.8 +/- 14.3 months. The immediate surgical mortality was 16% (two patients), from cardiac dysfunction. In the outpatient follow-up we observed that the symptoms, ischemic electrocardiographic changes, cardiac function and mitral regurgitation improved. Three cases progressed with supravalvar pulmonary stenosis during follow-up.

Conclusion: This heart disease should be suspected in every infant presenting with heart failure. Surgical correction with the Takeuchi procedure has proven efficient, with a low mortality rate. Cardiac function returns to normal and mitral regurgitation improves after surgical correction.