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Ann Pediatr Cardiol. 2019 Sep-Dec;12(3):318-320. doi: 10.4103/apc.APC_152_18.

First report of successfully palliating a hypoplastic left heart syndrome patient with anomalous left coronary artery from the pulmonary artery beyond Fontan.

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Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA.


We report a case of hypoplastic left heart syndrome with an anomalous left coronary artery from the pulmonary artery (ALCAPA) identified intraoperatively during the Stage-II palliation. Due to recurring ventricular fibrillation on sternotomy, a hybrid Stage-I palliation was performed. During comprehensive Stage-II, the ALCAPA was reimplanted in the neoaorta and measures, including a nontraditional Damus connection/arch reconstruction and classic bilateral Glenn procedures, were taken to avoid compression of the coronary artery. After a successful Fontan procedure, he continues to do well at 5 years old, becoming the first patient reported in the literature to survive all the three stages of single-ventricle palliation.


Anomalous left coronary artery from the pulmonary artery; Fontan; bidirectional Glenn; hypoplastic left heart syndrome

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