{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:07:21Z","timestamp":1789474041158,"version":"build-2803163510"},"reference-count":15,"publisher":"EDP Sciences","issue":"3","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Extra Corpor Technol","JECT"],"accepted":{"date-parts":[[2026,4,21]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare yet life-threatening congenital cardiac anomaly in which the left coronary artery originates from the pulmonary trunk, leading to severe myocardial ischemia, infarction, and progressive heart failure if untreated. Definitive management requires surgical reimplantation of the anomalous artery into the aorta, supported by meticulously tailored cardioplegia to protect the vulnerable pediatric myocardium, whose perfusion is further complicated by right-to-left coronary collaterals. This manuscript reports the findings of a targeted narrative review of operative videos, technical tutorials, and institutional protocols, synthesising practical knowledge on myocardial protection strategies for ALCAPA repair. Three techniques emerged as the most widely adopted and technically distinct: (1) simultaneous aortic and pulmonary-root administration of cold Custodiol\n                    <jats:sup>\u00ae<\/jats:sup>\n                    , providing prolonged single-dose crystalloid protection; (2) antegrade cold-blood cardioplegia supplemented by direct left-coronary ostial perfusion after main pulmonary artery transection, allowing staged protection during extended cross-clamp times; and (3) a classical normothermic blood protocol with repeated root doses and routine half-dose ostial delivery, offering dynamic electrolyte control and familiarity to most congenital teams. For each strategy, we summarise precise indications, operative setup, perfusion pressures, dosing schedules, and practical tips for managing collateral-driven early electrical activity. By distilling evidence and expert practice into a concise technical comparison, this narrative review provides congenital cardiac surgeons with an up-to-date, step-by-step reference for safe, effective myocardial protection in ALCAPA repair.\n                  <\/jats:p>","DOI":"10.1051\/ject\/2026013","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T18:46:57Z","timestamp":1777142817000},"page":"295-300","source":"Crossref","is-referenced-by-count":0,"title":["Cardioplegia strategies in ALCAPA surgery: A narrative review on practical comparison of techniques"],"prefix":"10.1051","volume":"58","author":[{"given":"Youssef","family":"El Dsouki","sequence":"first","affiliation":[{"name":"Faculty of Health, Medicine and Life Sciences, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopikrishnan","family":"Thalapathy","sequence":"additional","affiliation":[{"name":"Sheikh Khalifa Medical City","place":["United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1192-1908","authenticated-orcid":false,"given":"Ignazio","family":"Condello","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Varese Insubria, University of Insubria","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"250","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"issue":"4","key":"R1","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1177\/0267659119878006","volume":"35","author":"Bibevski","year":"2020","journal-title":"Perfusion."},{"issue":"1","key":"R2","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1186\/s40001-023-01372-4","volume":"28","author":"Elmahrouk","year":"2023","journal-title":"Eur J Med Res."},{"issue":"1","key":"R3","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1093\/icvts\/ivy199","volume":"28","author":"Drury","year":"2019","journal-title":"Interact Cardiovasc Thorac Surg."},{"issue":"7","key":"R4","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1177\/0267659114556402","volume":"30","author":"Fang","year":"2015","journal-title":"Perfusion."},{"issue":"4","key":"R5","doi-asserted-by":"crossref","first-page":"ezad041","DOI":"10.1093\/ejcts\/ezad041","volume":"63","author":"Stoica","year":"2023","journal-title":"Eur J Cardiothorac Surg."},{"issue":"Suppl 2","key":"R6","doi-asserted-by":"publisher","first-page":"131","DOI":"10.5606\/tgkdc.dergisi.2024.mep-32","volume":"32","author":"Sezen","year":"2024","journal-title":"Turk Gogus Kalp Damar Cerrahisi Derg."},{"issue":"11","key":"R7","doi-asserted-by":"publisher","first-page":"ytac432","DOI":"10.1093\/ehjcr\/ytac432","volume":"6","author":"Van den Eynde","year":"2022","journal-title":"Eur Heart J Case Rep."},{"issue":"1","key":"R8","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.athoracsur.2015.02.096","volume":"100","author":"Mong\u00e9","year":"2015","journal-title":"Ann Thorac Surg."},{"key":"R9","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1053\/tc.2000.6516","volume":"3","author":"Mong\u00e9","year":"2000","journal-title":"Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu."},{"issue":"4","key":"R10","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1016\/S0003-4975(00)02506-6","volume":"71","author":"Murthy","year":"2001","journal-title":"Ann Thorac Surg."},{"key":"R11","doi-asserted-by":"publisher","unstructured":"Estafanos M, Mashadi A, Said SM. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA): repair by translocation. CTSNet. 2023. https:\/\/doi.org\/10.25373\/ctsnet.22803239.v1.","DOI":"10.25373\/ctsnet.22803239.v1"},{"key":"R12","doi-asserted-by":"publisher","unstructured":"Bazylev VV, Chernogrivov IE, Chernogrivov AE. Aortic re-implantation in a case of anomalous origin of the left coronary artery from the right pulmonary artery in a toddler. Multimed Man Cardiothorac Surg. 2018;2018:mmcts.2018.013. https:\/\/doi.org\/10.1510\/mmcts.2018.013.","DOI":"10.1510\/mmcts.2018.013"},{"key":"R13","doi-asserted-by":"publisher","unstructured":"Di Pasquale L, Pr\u00eatre R, Cesnjevar R, Dave H. Repair of a remote pericommissural anomalous left coronary artery from the pulmonary artery. Multimed Man Cardiothorac Surg. 2022;2022:mmcts.2022.011. https:\/\/doi.org\/10.1510\/mmcts.2022.011.","DOI":"10.1510\/mmcts.2022.011"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1186\/s13019-024-02906-5","volume":"19","author":"Al-Obaidi","year":"2024","journal-title":"J Cardiothorac Surg."},{"issue":"8","key":"R15","doi-asserted-by":"publisher","first-page":"ytad340","DOI":"10.1093\/ehjcr\/ytad340","volume":"7","author":"Saito","year":"2023","journal-title":"Eur Heart J Case Rep."}],"container-title":["The Journal of ExtraCorporeal Technology"],"original-title":[],"link":[{"URL":"https:\/\/ject.edpsciences.org\/10.1051\/ject\/2026013\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:46:56Z","timestamp":1789472816000},"score":1,"resource":{"primary":{"URL":"https:\/\/ject.edpsciences.org\/10.1051\/ject\/2026013"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":15,"journal-issue":{"issue":"3"},"alternative-id":["ject250099"],"URL":"https:\/\/doi.org\/10.1051\/ject\/2026013","relation":{},"ISSN":["0022-1058","2969-8960"],"issn-type":[{"value":"0022-1058","type":"print"},{"value":"2969-8960","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}