Does pre-operative left ventricular function predict mitral valve function after anomalous left coronary artery from the pulmonary artery repair?

OBJECTIVE

To compare the progression of mitral valve (MV) function before and after anomalous left coronary artery from the pulmonary artery (ALCAPA) repair in those with preserved versus impaired left ventricular (LV) function.

METHODS

This is a post-hoc analysis of patients who underwent repair for ALCAPA at 22 Collaborative Research from the Pediatric Cardiac Intensive Care Society centers. Mitral regurgitation (MR) severity was compared on the basis of LV function at diagnosis and through 3 years of follow-up.

RESULTS

Among 228 patients, 76 had normal/mild LV dysfunction and 152 had moderate/severe LV dysfunction (median ejection fraction 60% vs 23%, P < .0001). Preoperatively, moderate or greater MR was more common with moderate/severe LV dysfunction (51% vs 26%, P < .001). At 3-year follow-up, those with moderate or greater MR decreased significantly in this group (51% to 13%; odds ratio, 0.11; 95% CI, 0.05-0.25; P < .0001), with no significant change in the normal/mild LV dysfunction group (26% to 16%; OR, 0.28; 95% CI, 0.06-1.39; P = .12).

CONCLUSIONS

In patients with ALCAPA and MV dysfunction with preserved LV function, MV recovery is less common, highlighting the consideration for concomitant MV repair.