Successful extracorporeal circulatory support after aorticreimplantation of anomalous left coronary artery

The development of severe heart failure is the main cause ofpostoperative mortality after the surgical treatment of anomalous origin ofthe left coronary artery from the pulmonary artery (ALCAPA). Two patientswith ALCAPA who developed low cardiac output and could not be weaned fromcardiopulmonary bypass (CPB) after aortic reimplantation of the anomalousleft coronary artery were successfully treated with a centrifugal leftventricular assist device (LVAD) and extracorporeal membrane oxygenation(ECMO). The circulation of a 10-month-old infant with severe leftventricular dysfunction was supported 192 h postoperatively with a LVAD anda 9-year-old boy with severe right ventricular failure received ECMOsupport for 99 h following surgery. Both patients survived and, 4 and 9months after surgery, are asymptomatic and have normal ventricularfunction. If CPB (up to 3 h) is not effective in improving ventricularfunction after surgery for ALCAPA, ECMO or LVAD must be used sincemyocardial recovery in these patients can occur only after prolongedextracorporeal circulatory support.