Name: direct re-implantation of left coronary artery into the aorta in adults with anomalous origin of left coronary artery from the pulmonary artery (alcapa)
Uploaded: 2017-04-24T15:00:00
Description: Watch this Scientific Journal Video about Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA at JoVE

这项工作是由瑞士心血管基金会RT的资助。

该协议遵循苏黎世大学的人类研究伦理委员会的机构准则。 1.制备用于外科<ol><li>干净，以典型的方式准备了外科手术室。为了便于外科医生和灌注师之间的通信，心脏心肺机放置到患者的左侧，相对于该外科医生。 </li><li>麻醉诱导前60分钟 - 由5毫克咪达唑仑，30的口服给药前用药患者。 </li><li>让患者根据标准的指导方针，与直接动脉和麻醉师中心静脉压访问进行监控。 1....

<ol>
	<li>Dodge-Khatami, A., Mavroudis, C., Backer, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anomalous+origin+of+the+left+coronary+artery+from+the+pulmonary+artery:+collective+review+of+surgical+therapy.">Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy.</a> Ann. Thorac. Surg. 74 (3), 946-955 (2002).</li><li>Keith, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+anomalous+origin+of+the+left+coronary+artery+from+the+pulmonary+artery.">The anomalous origin of the left coronary artery from the pulmonary artery.</a> Br. Heart J. 21 (2), 149-161 (1959).</li><li>Hauser, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Congenital+anomalies+of+the+coronary+arteries.">Congenital anomalies of the coronary arteries.</a> Heart. 91 (9), 1240-1245 (2005).</li><li>Wesselhoeft, H., Fawcett, J. S., Johnson, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=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.">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.</a> Circulation. 38 (2), 403-425 (1968).</li><li>Edwards, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+direction+of+blood+flow+in+coronary+arteries+arising+from+the+pulmonary+trunk.">The direction of blood flow in coronary arteries arising from the pulmonary trunk.</a> Circulation. 29 (2), 163-166 (1964).</li><li>Agustsson, M. H., Gasul, B. M., Fell, H., Graettinger, J. S., Bicoff, J. P., Waterman, D. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anomalous+origin+of+the+left+coronary+artery+from+the+pulmonary+artery+diagnosis+and+treatment+of+infantile+and+adult+types.">Anomalous origin of the left coronary artery from the pulmonary artery diagnosis and treatment of infantile and adult types.</a> JAMA. 180 (1), 15-21 (1962).</li><li>Roberts, S. M., Banbury, T., Mehta, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+rare+case+of+anomalous+left+coronary+artery+from+the+pulmonary+artery+(Bland-White-Garland+Syndrome)+in+a+68-year-old+woman.">A rare case of anomalous left coronary artery from the pulmonary artery (Bland-White-Garland Syndrome) in a 68-year-old woman.</a> Semin. Cardiothorac. Vasc. Anesth. , (2016).</li><li>Yau, J. M., Singh, R., Halpern, E. J., Fischman, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anomalous+origin+of+the+left+coronary+artery+from+the+pulmonary+artery+in+adults:+a+comprehensive+review+of+151+adult+cases+and+a+new+diagnosis+in+a+53-year-old+woman.">Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman.</a> Clin. Cardiol. 34 (4), 204-210 (2011).</li><li>Michielon, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anomalous+coronary+artery+origin+from+the+pulmonary+artery:+correlation+between+surgical+timing+and+left+ventricular+function+recovery.">Anomalous coronary artery origin from the pulmonary artery: correlation between surgical timing and left ventricular function recovery.</a> Ann. Thorac. Surg. 76 (2), 581-588 (2003).</li><li>Dodge-Khatami, A., Mavroudis, C., Backer, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Congenital+Heart+Surgery+Nomenclature+and+Database+Project:+anomalies+of+the+coronary+arteries.">Congenital Heart Surgery Nomenclature and Database Project: anomalies of the coronary arteries.</a> Ann. Thorac. Surg. 69 (4 Suppl), S270-S297 (2000).</li><li>Talwar, S., Jha, A. J., Choudhary, S. K., Gupta, S. K., Airan, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Repair+of+anomalous+left+coronary+artery+from+pulmonary+artery+(ALCAPA)+beyond+infancy.">Repair of anomalous left coronary artery from pulmonary artery (ALCAPA) beyond infancy.</a> Heart Surg. Forum. 16 (4), E210-E215 (2013).</li><li>Toumpourleka, M., Belitsis, G., Alonso, R., Rubens, M., Moat, N., Gatzoulis, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Late+presentation+and+surgical+repair+of+ALCAPA.">Late presentation and surgical repair of ALCAPA.</a> Int. J. Cardiol. 186, 207-209 (2015).</li><li>Quah, J. X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+management+of+the+older+adult+patient+with+anomalous+left+coronary+artery+from+the+pulmonary+artery+syndrome:+a+presentation+of+two+cases+and+review+of+the+literature.">The management of the older adult patient with anomalous left coronary artery from the pulmonary artery syndrome: a presentation of two cases and review of the literature.</a> Congenit. Heart Dis. 9 (6), E185-E194 (2014).</li><li>Kottayil, B. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anomalous+origin+of+left+coronary+artery+from+pulmonary+artery+in+older+children+and+adults:+direct+aortic+implantation.">Anomalous origin of left coronary artery from pulmonary artery in older children and adults: direct aortic implantation.</a> Ann. Thorac. Surg. 91 (2), 549-553 (2011).</li><li>Rajbanshi, B. G., Burkhart, H. M., Schaff, H. V., Daly, R. C., Phillips, S. D., Dearani, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+strategies+for+anomalous+origin+of+coronary+artery+from+pulmonary+artery+in+adults.">Surgical strategies for anomalous origin of coronary artery from pulmonary artery in adults.</a> J. Thorac. Cardiovasc. Surg. 148 (1), 220-224 (2014).</li><li>Neumann, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+results+after+repair+of+anomalous+origin+of+left+coronary+artery+from+the+pulmonary+artery:+Takeuchi+repair+versus+coronary+transfer.">Long-term results after repair of anomalous origin of left coronary artery from the pulmonary artery: Takeuchi repair versus coronary transfer.</a> Eur. J. Cardio-Thorac. Surg. , (2016).</li><li>Pe&#241;a, E., Nguyen, E. T., Merchant, N., Dennie, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ALCAPA+syndrome:+not+just+a+pediatric+disease.">ALCAPA syndrome: not just a pediatric disease.</a> Radiographics. 29 (2), 553-565 (2009).</li></ol>

这个协议描述了ALCAPA的直接再植入到主动脉与主左冠状动脉从根据道奇-哈塔米分类10中的肺动脉的右向窦起源成年患者的详细技术。心肌保护策略和肺动脉重建都清楚地证明。这个技术的主要关键步骤是通过左冠状动脉的慷慨动员表示实现无张力的吻合术。 长时间去饱和冠状动脉灌注容忍到成年期在少数个人。谁生存本到成年的临床表现的光谱，从没有症?...

从肺动脉（ALCAPA）左冠状动脉异常起源是一种罕见的先天性异常通常被视为分离的病变1。 ALCAPA的发生率估计为1 300000活产，0.24％和先天性心脏病2,3的0.46％之间，包括这是小儿心肌缺血和梗死的最常见的原因之一，如果不及时治疗，导致死亡率生活4的第一年90％。只有10 - 15％的婴儿存活由于大主导右冠状动脉（RCA）提供广泛的intercoronary络4的迅猛发展到成年。在新生儿期，高肺血管阻力和所得肺动脉（PA）的压力下确保顺行流从PA保持到异常左冠状动脉。由于pulmonarÿ血管阻力逐渐减小，顺行流向左冠状动脉降低。这最终导致流动的逆转，和左到右分流到PA，从而导致“冠状动脉偷5”。因此，左心室（LV）心肌灌注取决于intercoronary络从RCA 5,6。 冠状偷现象和逆行左侧冠状动脉血流提供慢性心内膜下缺血，这可能导致左心功能不全，缺血性二尖瓣反流，和由急性心肌缺血7沉淀恶性室性心律失常的基板。在成人患者的子集，在介绍的平均年龄为41岁，性别分布朝向女性患者的移位（女到男比：2：1）8。在此患者群体中，14％是无症状; 66％用本心绞痛，呼吸困难，心悸，或疲劳的症状;和现在有危及生命的症状，包括室性心律失常，晕厥和心源性猝死8 17％。危及生命的表现，平均年龄为33岁，心脏性猝死31岁8。因此，手术矫正高度只要作出诊断建议，不论年龄或intercoronary抵押1,9的程度。 根据异常左冠状动脉起源的ALCAPA进入主动脉的直接再植入是多种生理声音修复技术重建双冠状动脉灌注系统。最常见地，从ALCAPA右侧肺窦（PA的窦1），其面向主动脉窦其中主左冠状动脉通常起源（主动脉窦2）10 &lt;起飞/ SUP&gt;。这冠状动脉解剖是最适合于直接再注入技术。本报告的目的是描述，详细，对于成人患者在ALCAPA左冠状动脉的直接再植入技术。后面直接再注入的理由是优势-双冠状动脉的生理重建灌注它提供了一个在异常左冠状动脉与冠状动脉旁路移植11，12，13结合的结扎。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Heart surgery infrastructure:</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Heart Lung Machine</td>
			<td>Stockert</td>
			<td>SIII</td>
		</tr>
		<tr>
			<td>EOPA 24Fr. arterial cannula</td>
			<td>Medtronic</td>
			<td>77624</td>
		</tr>
		<tr>
			<td>Quickdraw 25Fr. femoral venous cannula</td>
			<td>Edwards</td>
			<td>QD25</td>
		</tr>
		<tr>
			<td>LV vent catheter 17Fr.</td>
			<td>Edwards</td>
			<td>E061</td>
		</tr>
		<tr>
			<td>Antegrade 9Fr. cardioplegia cannula</td>
			<td>Edwards</td>
			<td>AR012V</td>
		</tr>
		<tr>
			<td>Retrograde 14Fr. cardioplegia cannula&#160;</td>
			<td>Edwards</td>
			<td>NPC014&#160;</td>
		</tr>
		<tr>
			<td>Electrocautery</td>
			<td>Covidien</td>
			<td>Force FX</td>
		</tr>
		<tr>
			<td>Name</td>
			<td>Company</td>
			<td>Catalog number</td>
		</tr>
		<tr>
			<td>Sutures:</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Polypropylene 4/0</td>
			<td>Ethicon</td>
			<td>8871H</td>
		</tr>
		<tr>
			<td>Polypropylene 5/0</td>
			<td>Ethicon</td>
			<td>8870H</td>
		</tr>
		<tr>
			<td>Polypropylene 6/0</td>
			<td>Ethicon</td>
			<td>EH7400H</td>
		</tr>
		<tr>
			<td>Braided polyesther 2/0 ligature with polybutylate coating&#160;</td>
			<td>Ethicon</td>
			<td>X305H</td>
		</tr>
		<tr>
			<td>Intergard dacron graft 8 mm</td>
			<td>Maquet</td>
			<td>IGW0008-30</td>
		</tr>
		<tr>
			<td>Micro knife Sharpoint&#160;</td>
			<td>TYCO Healthcare PTY&#160;</td>
			<td>78-6900</td>
		</tr>
		<tr>
			<td>Name</td>
			<td>Company</td>
			<td>Catalog number</td>
		</tr>
		<tr>
			<td>Drugs:</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Midazolam</td>
			<td>Roche Pharma</td>
			<td>N05CD08</td>
		</tr>
		<tr>
			<td>Rocuronium</td>
			<td><a href="https://www.compendium.ch/comp/mnr/22695/de">MSD Merck Sharp &#38; Dohme&#160;</a></td>
			<td>M03AC09</td>
		</tr>
		<tr>
			<td>Propofol</td>
			<td>Fresenius Kabi</td>
			<td>N01AX10</td>
		</tr>
		<tr>
			<td>Fentanil</td>
			<td>Actavis</td>
			<td>N01AH01</td>
		</tr>
		<tr>
			<td>Name</td>
			<td>Company</td>
			<td>Catalog number</td>
		</tr>
		<tr>
			<td>Instruments:</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Cooley Derra anastomosis clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>DC40810-16</td>
		</tr>
		<tr>
			<td>Cooley vascular clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>DC40810-16</td>
		</tr>
		<tr>
			<td>Dissection forceps Carpentier</td>
			<td>Delacroix-Chevalier</td>
			<td>DC13110-28&#160;</td>
		</tr>
		<tr>
			<td>Scissors Metzenbaum</td>
			<td>Delacroix-Chevalier</td>
			<td>B351751</td>
		</tr>
		<tr>
			<td>Needle holder Ryder</td>
			<td>Delacroix-Chevalier</td>
			<td>DC51130-20&#160;</td>
		</tr>
		<tr>
			<td>Dissection forceps DeBakey</td>
			<td>Delacroix-Chevalier</td>
			<td>DC12000-21&#160;</td>
		</tr>
		<tr>
			<td>Micro needle holder Jacobson</td>
			<td>Delacroix-Chevalier</td>
			<td>DC50002-21&#160;</td>
		</tr>
		<tr>
			<td>Micro scisors Jacobson</td>
			<td>Delacroix-Chevalier</td>
			<td>DC20057-21&#160;</td>
		</tr>
		<tr>
			<td>Lung retractor</td>
			<td>Delacroix-Chevalier</td>
			<td>B803990</td>
		</tr>
		<tr>
			<td>Allis clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>DC45907-25&#160;</td>
		</tr>
		<tr>
			<td>O&#8217;Shaugnessy Dissector</td>
			<td>Delacroix-Chevalier</td>
			<td>B60650</td>
		</tr>
		<tr>
			<td>Vessel loop</td>
			<td>Medline</td>
			<td>VLMINY</td>
		</tr>
		<tr>
			<td>18 blade knife</td>
			<td>Delacroix-Chevalier</td>
			<td>B130180</td>
		</tr>
		<tr>
			<td>Leriche haemostatic clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>B86555</td>
		</tr>
	</tbody>
</table>

direct re-implantation of left coronary artery into the aorta in adults with anomalous origin of left coronary artery from the pulmonary artery (alcapa)

从肺动脉（ALCAPA）左冠状动脉起源异常是一种罕见的先天性异常是小儿心肌缺血和梗死的主要原因之一。如果不及时治疗，它会导致死亡率在生命的第一年90％。在谁存活到成年患者，冠状动脉偷窃现象，逆行左侧冠状动脉流量为慢性心内膜下缺血，这可能会导致左心功能不全，缺血性二尖瓣关闭不全，恶性室性心律失常和心源性猝死的基材。危及生命的表现，平均年龄为33岁，心脏性猝死31岁。因此，手术矫正高度一旦作出诊断建议，不论年龄。在成人型ALCAPA从肺动脉的右向窦起源的ALCAPA到主动脉的直接再注入是多种生理声音修复技术吨Ø重新建立双冠脉灌注系统和建议。这个协议描述成人型ALCAPA的直接再注入技术进入主动脉。

<html>介绍患者是一名48岁的女子与近期心绞痛加拿大心血管学会（CCS）毕业生III和偶尔的心悸发作呈现。她报告了三名波澜不惊怀孕。中度吸烟是主要的心血管危险因素。经胸超声心动图显示一个中度受损（45％）左室射血分数和无二尖瓣关闭不全。然后进行一个冠状动脉造影。它表明没有从主动脉引起的左冠状动脉主干的。右?...

Watch this Scientific Journal Video about Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA at JoVE

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

ALCAPA的手术矫正强烈建议，无论年龄或intercoronary抵押的程度。该协议提出了成年型ALCAPA的直接再植入到主动脉重新建立双冠状动脉灌注的技术。只要可行，直接再注入优选其它外科手术校正技术。

左冠状动脉直接再注入与从肺动脉左冠状动脉起源异常成人主动脉（ALCAPA）

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ...

Research

JoVE Journal

Medicine

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Use of a Hanging Weight System for Coronary Artery Occlusion in Mice

悬重系统的使用在小鼠冠状动脉闭塞

Murine studies of acute injury are an area of intense investigation, as knockout mice for different genes are becoming increasingly available 1-38. ...

科研

医学

Coronary Artery Ligation and Intramyocardial Injection in a Murine Model of Infarction

结扎冠状动脉内注射在小鼠模型梗死

Mouse models are a valuable tool for studying acute injury and chronic remodeling of the myocardium in vivo.  With the advent of genetic modifications to ...

Modified Technique for Coronary Artery Ligation in Mice

改性技术在小鼠冠状动脉结扎

Myocardial infarction (MI) is one of the most important causes of mortality in humans1-3. In order to improve morbidity and mortality in patients with MI ...

A Murine Model of Myocardial Ischemia-reperfusion Injury through Ligation of the Left Anterior Descending Artery

心肌缺血再灌注损伤的通过左前降支结扎小鼠模型

Acute or chronic myocardial infarction (MI) are cardiovascular events resulting in high morbidity and mortality. Establishing the pathological mechanisms ...

Permanent Ligation of the Left Anterior Descending Coronary Artery in Mice: A Model of Post-myocardial Infarction Remodelling and Heart Failure

左冠状动脉前降支的小鼠结扎：对心肌梗死后重塑和心衰模型

Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It ...

Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

冠脉流量和冠状动脉血流储备用小鼠压力超负荷基于模型的超声评估

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow ...

Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery

左心房，主动脉和肺动脉的超声心动图小鼠

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic ...

Murine Left Anterior Descending (LAD) Coronary Artery Ligation: An Improved and Simplified Model for Myocardial Infarction

Murine Left Anterior Descending LAD Coronary Artery Ligation: An Improved and Simplified Model for Myocardial Infarction

鼠左前降支（LAD）冠状动脉结扎：改进和简化模型的心肌梗死

Ischemic heart disease (IHD), or acute coronary syndrome (ACS), is one of the leading causes of death in the United States. IHD is characterized by ...

Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans

非门控断层扫描的冠状动脉钙化识别

Coronary artery calcification (CAC) provides an objective measure of coronary artery disease and can readily be identified on non-gated computed ...

Murine Myocardial Infarction Model using Permanent Ligation of Left Anterior Descending Coronary Artery

使用左前部降冠动脉的永久结扎的月心肌梗死模型

Myocardial infarction (MI) and acute coronary diseases are among the most prominent causes of death in population with western lifestyle. The murine ...