Resynchronization and strain recovery following reimplantation of anomalous coronary artery: a tissue Doppler and three-dimensional echocardiographic study.

Resynchronization may play a significant role in recovery following surgical reimplantation of anomalous left coronary artery from the pulmonary artery (ALCAPA). Three-dimensional echocardiography and tissue Doppler may quantify this recovery. A 6-week-old infant presented with signs of congestive heart failure due to ALCAPA. Two-dimensional echocardiography showed a severely dilated left ventricular (LV) cardiomyopathy and the presence of ALCAPA was confirmed by catheterization. Three-dimensional echocardiography and tissue Doppler imaging showed severe abnormalities of systolic and diastolic synchrony and decreased contractility with a left ventricular ejection fraction (LVEF) of 13%. The infant underwent surgical coronary reimplantation and was discharged 5 weeks later with an LVEF of 54%. Serial quantitative assessment showed resynchronization and normalization of global LV function following reimplantation. However, segmental contractility improved significantly but remained depressed at discharge. The immediate recovery observed following reimplantation of anomalous coronary may be largely due to resynchronization.