Abstract
Objective. To describe the results of simple photon emission computed tomography with 99mTc-technetril or positron emission tomography
with 13N-ammonium – to assess myocardial perfusion; and positron emission tomography of the myocardium with 18F-fluorodeoxyglucose
– for assessment of myocardial metabolism in 46 patients with Bland–White–Garland syndrome.
Material and methods. During the period from 2009 to 2014 there was carried out a retrospective analysis of treatment of 75 patients
with an abnormal origin of left coronary artery from the pulmonary artery with accompanied complications (the presence of left ventricle
(LV) aneurysm, the presence of severe mitral insufficiency – more than 2 degree, a significant decrease in LV ejection fraction –
less than 40%, the deviation of Z-score size and end-diastolic LV volume by more than 3, signs of severe heart failure due to extensive
ischemic myocardial injury, the need for cardiotonic support and pulmonary ventilation in the preoperative period). These
patients aged of 1.5 months to 50 years were treated A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Ministry of Health
of the Russian Federation, 46 (61.3%) of them were examined with radionuclide methods of visualization of the myocardium – simple
photon emission computed tomography or positron emission tomography of the myocardium.
Results. In the study there was conducted the analysis of the radionuclide survey regarding to the presence or absence of a welldeveloped
network of the collaterals; and depending on the outcome of treatment. Through comparison of the results of radionuclide
methods of investigation, it is possible to determine the degree of reversibility of ischemic damage to the myocardium. Even if you
have scarring in some segments of the myocardium, the remaining viable myocardium shows pronounced signs of hibernation in the
whole area of perfusion defect. Therefore, almost all patients, including patients with aneurysms of the LV, hibernating myocardium
area stays large, and the larger perfusion defect, is the larger hibernation area, despite the presence of the scar.
Conclusion. The modern diagnostic concept of anomalous origin of the left coronary artery from the pulmonary artery is based on
the determining of the extent and reversibility of ischemic injury of the myocardium, which plays a crucial role in the predicting of the
treatment outcome, and therefore, in the selection of the optimal treatment strategy.
References
- Yamanaka O., Hobbs R.E. Coronary artery anomalies in
126.595 patients undergoing coronary arteriography. Cathet.
Cardiovasc. Diagn. 1990; 21: 28–40.
- Kirklin J.W., Barratt-Boyes B.G. Congenital anomalies of the
coronary arteries. In: Cardiac surgery. New York: John Wiley;
1986: 945–69.
- Keith J.D. The anomalous origin of the left coronary artery
from the pulmonary artery. Br. Heart J. 1959; 21: 149–61.
- Menahem S., Venables A.W. Anomalous left coronary artery
from the pulmonary artery: a 15 year sample. Br. Heart J.
1987; 58: 378–84.
- George J.M., Knowlan D.M. Anomalous origin of the left coronary
artery in an adult. N. Eng. J. Med. 1959; 261: 993.
- Рогова Т.В. Ишемическое ремоделирование левого желудочка при аномальном отхождении левой коронарной артерии
от легочного ствола: Дис. … д-ра мед. наук. М.; 2014.
- Hoashi T., Hirsch J.C., Bove E.L., Ohye R.G. Late reoperation
after reimplantation of an anomalous single coronary artery
from the pulmonary artery. Ann. Thorac. Surg. 2010; 89:
285–7.
- Бокерия Л.А., Шаталов К.В., Арнаутова И.В. Аномальное
отхождение левой коронарной артерии от легочной артерии (синдром Бланда–Уайта–Гарланда). М.: НЦССХ им.
А.Н. Бакулева РАМН; 2010.
- Braunwald E., Rutherford J.D. Reversible ischemic left ventricular
dysfunction: evidence for the «hibernating myocardium».
J. Am. Coll. Cardiol. 1986; 8 (6): 1467–70.
- Rahimtoola S.H. The hibernating myocardium. Am. Heart. J.
1989; 117: 211–21.
- Kloner R.A., Braunwald E. The stunned myocardium: prolonged,
postischemic ventricular dysfunction. Circulation.
1982; 66: 1146–9.
- Bonow R.O. Myocardial hibernation: a noninvasive physician's
point of view. Ital. Heart J. 2002; 3 (5): 285–90.
- Bolli R., Marba′n E. Molecular and cellular mechanisms of
myocardial stunning. Physiol. Rev. 1999; 97 (2): 609–34.
- Vanoverschelde J., Wijns W., Depre C. et al. Mechanisms of
chronic regional postischemic dysfunction in humans: new
insights from the study of noninfarcted collateral-depent
myocardium. Circulation. 1993; 87 (1): 513–23.
- Асланиди И.П., Шурупова И.В., Рогова Т.В., Деревянко Е.П., Трифонова Т.А., Мухортова О.В. и др. Особенности перфузии и метаболизма миокарда у пациентов с аномальным отхождением левой коронарной артерии от легочной артерии по данным перфузионной сцинтиграфии с
99mТс-технетрилом и позитронно-эмиссионной томографии с 18F-фтордезоксиглюкозой. Бюллетень НЦССХ им.
А.Н. Бакулева РАМН. 2009; 6: 39–48.
- Бокерия Л.А., Асланиди И.П., Шурупова И.В., Вахромеева М.Н., Рогова Т.В., Деревянко Е.П. и др. Оценка жизнеспособности миокарда у больных с аномальным отхожде-
нием левой коронарной артерии от легочной артерии с помощью методов ОФЭКТ с 99mТс-тетрофосмином и ПЭТ.
Материалы Невского радиологического форума. СПб.;
2005: 116–7.
- Бокерия Л.А., Асланиди И.П., Ким А.И., Рогова Т.В., Крюков
В.А., Вахромеева М.Н. и др. Информативность различных
диагностических методов при АОЛКА. Материалы Х ежегодной сессии НЦССХ им. А.Н. Бакулева РАМН с Всероссийской конференцией молодых ученых. Бюллетень
НЦССХ им. А.Н. Бакулева РАМН. Приложение. 2006; 3: 35.
- Бокерия Л.А., Асланиди И.П., Шурупова И.В., Мухортова О.В., Башерова М.Н., Екаева И.В. Хроническая ишемия
миокарда у детей с АОЛКА – оценка перфузии и метаболизма миокарда до операции. Материалы ХIII Всероссийского
съезда сердечно-сосудистых хирургов. Бюллетень НЦССХ
им. А.Н. Бакулева РАМН. Приложение. 2007; 6: 35.
- Шурупова И.В., Рогова Т.В., Асланиди И.П., Серов Р.А.,
Шавман М.Г. Позитронно-эмиссионная томография миокарда у ребенка с синдромом Бланда–Уайта–Гарланда: диагностика рубцовых и обратимых ишемических изменений
левого желудочка. Бюллетень НЦССХ им. А.Н. Бакулева
РАМН. 2014; 2: 44–50.
- Ferrer P.L., Gottlieb S., Garcin O.L., Miale A. Non-invasive
diagnosis of anomalous left coronary artery in the young with
Thallium-201 myocardial imaging. Paed. Res. 1977; 11 (4):
389.
- Hernandez-Pampaloni M. et al. Perfusion and myocardial viability
in infants. JACC. 2003; 41 (4): 618–26.
- Gelfand M.J., Parisi M.T., Treves S.T. et al. Pediatric radiopharmaceutical
administered doses: 2010 North American consensus
guidelines. J. Nucl. Med. 2011; 52: 318–22.
- Арнаутова И.В. Эволюция подходов к хирургическому лечению аномального отхождения левой коронарной арте-
рии от легочной артерии: Дис. … д-ра мед. наук. М.; 2013.
- Miyamoto T., Horigome H., Saco H., Yamada M., Inai K.,
Takeda T. et al. Anomalous origin of the left coronary artery
from the pulmonary trunk with myocardial infarction and
severe left ventricular dysfunction in infancy – assessment
of myocardial damage using SPECT studies with 201TlCl and
123I-BMIPP. Jap. J. Nucl. Med. 1996; 33 (2): 169–74.
- Махалин М.В. Хирургическое лечение дисфункции митрального клапана при синдроме Бланда–Уайта–Гарланда в
раннем детском возрасте: Дис. … кан. мед. наук. М.; 2007.
- Azakie A., Russell J.L., McCrindle B.W., VanArsdell G.S.,
Benson L.N., Coles J.G. et al. Anatomic repair of anomalous
left coronary artery from the pulmonary artery by aortic reimplantation:
early survival, patterns of ventricular recovery and
late outcome. Ann. Thorac. Surg. 2003; 75: 1535–41.
- Lange R., Vogt M., Horer J., Cleuziou J., Menzel A., Holper K.
Long-term results of repair of anomalous origin of the left
coronary artery from the pulmonary artery. Ann. Thorac.
Surg. 2007; 83: 1463–71.
- Hanna B., Colan S.D., Bridges N.D., Mayer J.E. Clinical and
myocardial status after left ventriculotomy for ventricular septal
defect closure. J. Am. Coll. Cardiol. 1991; 17 (Suppl.):
110A.
- Vouhe P.R., Tamisier D., Sidi D., Vernant F., Mauriat P.,
Pouard P., Leca F. Anomalous left coronary artery from the
pulmonary artery: results of isolated aortic reimplantation.
Ann. Thorac. Surg. 1992; 54 (4): 621–6; discussion 627.
- Stern H., Sauer U., Locher D. et al. Left ventricular function
assessed echocardiography and myocardial perfusion
assessed with scintigraphy under dipyridamole stress in pediatric
patients after repair of anomalous origin of the left coronary
artery from the pulmonary artery. J. Thorac. Cardiovasc.
Surg. 1992; 106: 723–32.
- Sauer U., Stern H., Meisner H., Buhlmeyer K., Sebening F.
Risk factors for peri-operative mortality in children with anomalous
origin of the left coronary artery from the pulmonary
artery. J. Thorac. Cardiovasc. Surg. 1992; 104: 696–705.
- Cochrane A.D., Goh T.H., Austin C., Karl T.R. Incipient left
ventricular rupture complicating anomalous left coronary
artery. Ann. Thorac. Surg. 1999; 67: 254–6.
- Bunton R., Jonas R.A., Lang P., Rein A.J., Castaneda A.R.
Anomalous origin of the left coronary artery from pulmonary
artery: ligation versus establishment of a two coronary artery
system. J. Thorac. Cardiovasc. Surg. 1987; 93: 103–8.
- Jin Z., Berger F., Uhlemann F., Schroder C., Hetzer R., Alexi-
Meskhishvili V. et al. Improvement in left ventricular dysfunction
after aortic reimplantation in 11 consecutive paediatric
patients with anomalous origin of the left coronary artery from
the pulmonary artery. Early results of a serial echocardiographic
follow-up. Eur. Heart J. 1994; 15: 1044–9.
- Lambert V., Tuochot A., Losay J. et al. Midterm results after
surgical repair of the anomalous origin of the coronary artery.
Circulation. 1996; 949 (9 Suppl.): 1138–43.
- Elsasser A., Schlepper M., Klovekorn W.P., Cai W.J.,
Zimmermann R., Muller K.D. et al. Hibernating myocardium –
an incomplete adaptation to ischemia. Circulation. 1997;
96 (6): 2920–30.
