A challenging surgery of Resternotomy and ALCAPA repair in a post-operative case of Mitral Valve Replacement.

A 35-year-old patient, Mr. P. Shiva Shankar was suffering from a rare congenital anomaly, known as ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery), in which the left Coronary artery originates from pulmonary artery instead of aorta base. The complex surgery to correct the anomaly lasted over ten hours and was performed by Senior Cardio-Thoracic Surgeons at Apollo Hospitals, Visakhapatnam ,Dr.Jaideep Kumar Trivedi and Dr. Sujit Kumar Mohanty. World over, there are no records in medical literature, of this surgery being performed.

The incidence of ALCAPA is extremely rare, 1 in 3, 00,000 live births and constitutes just about0.25%to 0.5% of all cases of congenital heart diseases. 90% of the untreated patients would not survive beyond a year and is miraculously rare to see someone surviving till adulthood.

The patient underwent mitral valve replacement at the age of 32, for severe mitral regurgitation, with his valve being totally damaged. Dr. Trivedi had performed the surgery successfully, two years ago. Recently, he had an episode of chest pain and was referred to cardiologist, Dr. A Suresh. On performing an angiography, he was surprised to see that the left main coronary artery was originating from pulmonary artery. CT-Angio reports confirmed the diagnosis and without any further delay he referred the patient to Dr. Trivedi for Surgery.

Patient underwent Resternotomy Surgery whereby ALCAPA closure was done and re-vascularization of the heart was performed by new bypasses to the left coronary -which is nothing less than a challenge. As the patient had a weak pumping heart, he was put up on IABP machine. The surgery lasted for 10 hours and the patient was on ventilator for 4 days. The team of Cardiac Anesthetist’s Dr. Ravi, Dr. Sunil and Dr. Ramakrishna, took special care of the patient in the ICU. On day 5, he was weaned off the ventilator and IABP was removed on day 7. After 10 days in the ICU, his condition improved and his health stabilized, post which he was shifted to the ward and 15 days later Mr. P. Shiva Shankarwas discharged.