Recovery of left ventricular function in children following repair of anomalous coronary artery origin according to clinical presentation: a multicenter study from Latin America

Anomalous origin of a coronary artery from the pulmonary artery is a rare congenital anomaly associated with myocardial ischemia, ventricular dysfunction, and heart failure. Whether postoperative ventricular recovery differs according to clinical presentation remains incompletely understood. We performed a retrospective multicenter cohort study of all consecutive pediatric patients undergoing surgical repair of anomalous coronary artery origin during a 20-year period at two specialized cardiovascular centers in Latin America. Patients were categorized as asymptomatic, acute heart failure, or compensated chronic heart failure at diagnosis. The primary outcome was the change in left ventricular ejection fraction (LVEF) from preoperative assessment to hospital discharge. Fifty-one patients were included; 27% were asymptomatic, 51% presented with acute heart failure, and 22% with chronic heart failure. Anomalous left coronary artery from the pulmonary artery accounted for 92.1% of cases. Patients with heart failure presented with more advanced preoperative disease and greater support requirements. Coronary reimplantation was the most common surgical technique (68.6%). LVEF improved significantly after surgery across the cohort and normalized by discharge in all presentation groups, with no differences in postoperative LVEF among groups ( p = 0.918). Recovery of ventricular function (LVEF > 50%) was achieved in 86.3% of patients. Despite similar ventricular recovery, heart failure presentation was associated with greater postoperative morbidity and longer hospitalization. No statistically significant differences in early postoperative of left ventricular function were observed among the clinical presentation groups. However, patients presenting with heart failure experienced greater postoperative morbidity, underscoring the importance of early diagnosis and timely surgical intervention.