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

Dette arbejde blev støttet af en bevilling fra den schweiziske Cardiovascular Foundation til RT.

Protokollen følger de institutionelle retningslinier i den menneskelige videnskabsetisk komité af universitetet i Zürich. 1. Forberedelse til kirurgi <ol><li> Rens og forberede den kirurgiske suite i en typisk måde. At lette kommunikationen mellem kirurgen og perfusionist placere hjerte-lunge-maskine til venstre for patienten, modsat til kirurgen. </li><li> Pre-medicinerer patienten ved oral administration af 5 mg midazolam, 30 - 60 min før induktion af anæstesi. </li><li> Lad patien...

<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>

Denne protokol beskriver en detaljeret teknik til direkte genbrug implantation af ALCAPA ind i aorta i en voksen patient med oprindelsen af vigtigste venstre koronararterie fra højre-vender sinus af lungepulsåren henhold til Dodge-Khatami klassificering 10. Den myokardiebeskyttelse strategi og genopbygningen af ​​lungepulsåren er klart demonstreret. Den større kritiske trin af denne teknik er repræsenteret ved den generøse mobilisering af den venstre koronararterie at opnå en spænding...

Anomale oprindelse venstre koronararterie fra lungepulsåren (ALCAPA) er en sjælden medfødt anomali sædvanligvis ses som en isoleret læsion 1. Forekomsten af ALCAPA anslås til 1 i 300.000 levendefødte, der omfatter mellem 0,24% og 0,46% af medfødte hjertesygdomme 2, 3. Det er en af de mest almindelige årsager til myocardial iskæmi og infarkt hos børn og, hvis det ikke behandles, resulterer i en 90% dødelighed i det første leveår 4. Kun 10 - 15% af spædbørn overlever til voksenalderen på grund af den hurtige udvikling af en stor dominerende højre kranspulsåre (RCA) med omfattende intercoronary soeskende 4. Under den neonatale periode, høj pulmonale vaskulære modstand og de resulterende lungepulsåren (PA), tryk sikrer, at antegrade flow opretholdes fra PA i den anomale venstre koronararterie. Da pulmonary vaskulær modstand aftager gradvist, fremadrettet strømning til venstre koronararterie reducerer. Dette fører i sidste ende til tilbageførsel af flow, og venstre-til-højre rangering ind i PA, hvilket resulterer i en &quot;koronar stjæle 5.&quot; Således, venstre ventrikel (LV) myocardial perfusion afhænger intercoronary kollateraler fra en RCA 5, 6. Den koronare stjæle fænomen og retrograd venstre-sidet koronargennemstrømning tilvejebringe et substrat til kronisk subendokardiale iskæmi, som kan føre til dysfunktion i venstre ventrikel, iskæmisk mitralregurgitation, og maligne ventrikulære arytmier udfældes ved akut myocardieiskæmi 7. I en undergruppe af voksne patienter var den gennemsnitlige alder ved præsentation er 41 år, med et skift i sex fordeling mod kvindelige patienter (Kvinde-mand-forholdet: 2: 1) 8. I denne patientpopulation, 14% er asymptomatiske; 66% til stede medsymptomer på angina, dyspnø, palpitationer, eller træthed; og 17% til stede med livstruende symptomer, herunder ventrikulære arytmier, synkope, og pludselig hjertedød 8. Gennemsnitsalderen for livstruende præsentation er 33 år, og for pludselig hjertedød 31 år 8. Derfor er kirurgisk korrektion stærkt anbefales, så snart diagnosen stilles, uanset alder og graden af intercoronary sikkerhedsstillelse 1, 9. Afhængigt af oprindelsen af ​​den anomale venstre koronararterie, direkte genbrug implantation af ALCAPA i aorta er den mere fysiologisk lyd reparation teknik til at genetablere den dobbelt koronar perfusion system. Mest almindeligt, ALCAPA letter fra den højre lunge sinus (sinus 1 af PA), som vender aortabihulen hvor de vigtigste venstre koronararterie normalt stammer (sinus 2 af aorta) 10 &lt;/ Sup&gt;. Denne koronaranatomi er mest egnet til den direkte genbrug implantationsteknik. Formålet med denne rapport er at beskrive i detaljer den teknik til direkte genbrug implantation af venstre koronararterie i ALCAPA i voksne patienter. Rationalet bag direkte genbrug implantation er fordelen-fysiologiske genetablering af dual-koronar perfusion-det tilbyder over ligering af den anomale venstre koronar kombineret med koronar bypass 11, 12, 13.

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		<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)

Anomale oprindelse venstre koronararterie fra lungepulsåren (ALCAPA) er en sjælden medfødt anomali som er en af ​​hovedårsagerne til myokardieiskæmi og infarkt hos børn. Hvis venstre ubehandlet, resulterer det i en 90% dødelighed i det første leveår. Hos patienter, der overlever til voksenalderen, coronar stjæle fænomen og retrograd venstre-sidet koronargennemstrømning tilvejebringe et substrat til kronisk subendokardiale iskæmi, som kan føre til dysfunktion i venstre ventrikel, iskæmisk mitralregurgitation, maligne ventrikulære arytmier, og pludselig hjertedød. Gennemsnitsalderen for livstruende præsentation er 33 år og af pludselig hjertedød 31 år. Derfor er kirurgisk korrektion stærkt anbefales, så snart diagnosen stilles, uanset alder. I voksen-typen ALCAPA stammer fra højre vendende sinus af lungepulsåren, direkte genbrug implantering af ALCAPA i aorta er det mere fysiologisk forsvarlig reparationsteknik to genetablere dual-koronar perfusion systemet og anbefales. Denne protokol beskriver teknikken med direkte genbrug implantation af voksen-typen ALCAPA i aorta.

<html> Præsentation Patienten var en 48-årig kvinde præsenterer med den nylige udbrud af angina canadiske Cardiovascular Society (CCS) grad III og lejlighedsvise hjertebanken. Hun rapporterede tre begivenhedsløst graviditeter. Moderat rygning var den vigtigste kardiovaskulær risikofaktor. Transtorakal ekkokardiografi viste en moderat nedsat (45%) venstre ventrikel uddrivningsfraktion og ingen mitralregurgitation. En koronaran...

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

Kirurgisk korrektion af ALCAPA anbefales, uanset alder og graden af ​​intercoronary sikkerhedsstillelse. Denne protokol udgør en teknik til direkte genbrug implantation af voksen-typen ALCAPA i aorta at genetablere den dual-koronar perfusion. Når det er muligt, er direkte genbrug implantation foretrak at andre kirurgiske korrektion teknikker.

Direkte Re-implantation af venstre koronararterie i aorta i Voksne med Anomalous Oprindelse af venstre koronararterie fra lungepulsåren (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 ...

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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)

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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 ...

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

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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 ...

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

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

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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans

At identificere koronararterie forkalkning på beregnet ikke-gated tomografi scanninger

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

Murine myokardieinfarkt model ved hjælp af permanent ligation af venstre anterior faldende koronararterie

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