Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-15T13:26:49.607Z Has data issue: false hasContentIssue false
  • English
  • Français

An alternative technique for transfer of anomalous left coronary artery from the pulmonary trunk in children and adults using autogenous aortic and pulmonary arterial flaps

Published online by Cambridge University Press:  14 February 2008

Ujjwal K. Chowdhury ,
Shyam S. Kothari ,
Chetan D. Patel ,
Anand K. Mishra ,
Priya Jagia ,
Ganapathy K. Subramaniam ,
Kizakke K. Pradeep  and
Raghu M. Govindappa
Ujjwal K. Chowdhury*
Affiliation:
Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
Shyam S. Kothari
Affiliation:
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
Chetan D. Patel
Affiliation:
Department of Nuclear Cardiology, All India Institute of Medical Sciences, New Delhi, India
Anand K. Mishra
Affiliation:
Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
Priya Jagia
Affiliation:
Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
Ganapathy K. Subramaniam
Affiliation:
Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
Kizakke K. Pradeep
Affiliation:
Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
Raghu M. Govindappa
Affiliation:
Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
*
Correspondence to: Dr Ujjwal K. Chowdhury, M.Ch, Diplomate NB, Additional Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi-110029, India. Tel: 91-11-26588700, 91-11-26588500, Ext. 4835; Fax: 91-11-26588663, 26588641; E-mails: [email protected], [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Direct re-implantation of an anomalous left coronary artery into the aorta is the preferred surgical option for creating a dual coronary arterial system in patients in whom the anomalous artery originated from the pulmonary trunk. This technique, however, is applicable only when the anomalous artery arises from the right posterior pulmonary sinus. We report a new technique for re-implantation using combined autogenous aortic and pulmonary arterial flaps in situations when a direct connection was not possible.

Patients and methods

We have treated 4 patients, aged 3 months, 6 months, 18 months, and 27 years respectively, who presented with anomalous origin of the left coronary artery from the left posterior pulmonary sinus. We used our proposed technique for transfer because lack of coronary arterial length, diminished vessel elasticity, and extensive collaterals around the pulmonary sinuses prevented direct attachment.

Results

There was no early or late death. Postoperatively, all patients are in functional class I, with good biventricular function at a median follow-up of 74 months, with a range from 9 to 96 months. Postoperative coronary angiography in our 4th patient showed good arterial flow, without any distortion.

Conclusions

The potential benefits of this modification of the trapdoor technique are excellent operative exposure, use of autogenous and viable tissue capable of further growth, avoidance of injury to the aortic and pulmonary valvar apparatus and production of obstruction within the right ventricular outflow tract, complete elimination of use of pericardium for augmentation of the neo-aortic tube, achievement of the anastomosis with correct angling and length, and the possibility of implantation in all patients, including adults, regardless of the distance from the aorta or the coronary arterial configuration.

Keywords

Congenital heart diseaseBland-White-Garland syndromecardiac anatomy
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 2 , April 2008 , pp. 165 - 176
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Dodge-Khatami, A, Mavroudis, C, Backer, CL. Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 2002; 74: 946–955.CrossRefGoogle ScholarPubMed
2. Vouhe, PR, Baillot-Vemant, F, Trinquet, F, et al. Anomalous left coronary artery from the pulmonary artery in infants: Which operation and when? J Thorac Cardiovasc Surg 1987; 94: 192–199.CrossRefGoogle Scholar
3. Turley, K, Szarnicki, RJ, Flachsbart, KD, Richter, RC, Popper, RW, Tarnoff, H. Aortic implantation is possible in all cases of anomalous origin of the left coronary artery from the pulmonary artery. Ann Thorac Surg 1995; 60: 84–89.CrossRefGoogle ScholarPubMed
4. Schwartz, ML, Jonas, RA, Colan, SD. Anomalous origin of left coronary artery from pulmonary artery: recovery of left ventricular function after dual coronary repair. J Am Coll Cardiol 1997; 30: 547–553.CrossRefGoogle ScholarPubMed
5. Selzman, CH, Zimmerman, MA, Campbell, DN. Anomalous left coronary artery from the pulmonary artery in an adult with preserved left ventricular function. J Card Surg 2003; 18: 25–28.CrossRefGoogle Scholar
6. Takeuchi, S, Imamura, H, Katsumoto, K, et al. New surgical method for repair of anomalous left coronary artery from pulmonary artery. J Thorac Cardiovasc Surg 1979; 78: 7–11.CrossRefGoogle ScholarPubMed
7. Alexi-Meskishvili, V, Hetzer, R, Weng, Y, et al. Anomalous origin of the left coronary artery from the pulmonary artery: early results with direct aortic reimplantation. J Thorac Cardiovasc Surg 1994; 108: 354–362.CrossRefGoogle ScholarPubMed
8. Moodie, DS, Fyfe, D, Gill, CC, et al. Anomalous origin of the left coronary artery from the pulmonary artery (Bland-White Garland syndrome) in adult patients: long-term follow-up after surgery. Am Heart J 1983; 106: 381–388.CrossRefGoogle ScholarPubMed
9. Vigneswaran, WT, Campbell, DN, Pappas, G, Wiggins, JW, Wolfe, RW, Clarke, DR. Evolution of the management of anomalous left coronary artery: A new surgical approach. Ann Thorac Surg 1989; 48: 560–564.CrossRefGoogle ScholarPubMed
10. Chan, RK, Hare, DL, Buxton, BF. Anomalous left main coronary artery arising from the pulmonary artery in an adult: treatment by internal mammary artery grafting. J Thorac Cardiovasc Surg 1995; 109: 393–394.CrossRefGoogle Scholar
11. Arciniegas E Farooki, ZQ, Harkmi, M, Green, EW. Management of anomalous left coronary artery from the pulmonary artery. Circulation 1980; 62 (1 Suppl): 180–189.Google Scholar
12. Sese, A, Imoto, Y. New technique in the transfer of an anomalously originated left coronary artery to the aorta. Ann Thorac Surg 1992; 53: 527–529.CrossRefGoogle ScholarPubMed
13. Tashiro, T, Todo, K, Hamta, Y, Yasunaga, H, Nagata, M, Nakamura, M. Anomalous origin of the left coronary artery from the pulmonary artery: new operative technique. J Thorac Cardiovasc Surg 1993; 106: 718–722.CrossRefGoogle ScholarPubMed
14. Murthy, KS, Krishnanaik, S, Mohanty, SR, Varghese, R, Cherian, KM. A new repair for anomalous left coronary artery. Ann Thorac Surg 2001; 71: 1384–1386.CrossRefGoogle ScholarPubMed
15. Katsumata, T, Westaby, S. Anomalous left coronary artery from the pulmonary artery: A simple method for aortic implantation with autogenous arterial tissue. Ann Thorac Surg 1999; 68: 1090–1091.CrossRefGoogle ScholarPubMed
16. Neirotti, R, Nijveld, A, Ithuralde, M, et al. Anomalous origin of the left coronary artery from the pulmonary artery: repair by aortic reimplantation. Eur J Cardiothorac Surg 1991; 5: 368–372.CrossRefGoogle ScholarPubMed
17. El-Said, GM, Ruzyllo, W, Williams, R, et al. Early and late result of saphenous vein graft for anomalous origin of left coronary artery from pulmonary artery. Circulation 1973; 48 (III Suppl): III2–III6.CrossRefGoogle ScholarPubMed
18. Singh, TP, Carli, MF, Sullivan, NM, Leonen, MF, Morrow, WR. Myocardial flow reserve in long-term survivors of reports of anomalous left coronary artery from pulmonary artery. J Am Coll Cardiol 1998; 31: 437–443.CrossRefGoogle Scholar
19. Backer, CL, Stout, MJ, Zales, VR, et al. Anomalous origin of the left coronary artery. A twenty-year review of surgical management. J Thorac Cardiovasc Surg 1992; 103: 1049–1058.CrossRefGoogle ScholarPubMed
20. Grace, RR, Angelini, P, Cooley, DA. Aortic implantation of anomalous left coronary artery from pulmonary artery. Am J Cardiol 1977; 39: 608–613.CrossRefGoogle Scholar
21. Laks, H, Ardehali, A, Grant, PW, Allada, V, Angeles, L. Aortic implantation of anomalous left pulmonary artery: An improved surgical approach. J Thorac Cardiovasc Surg 1995; 109: 519–523.CrossRefGoogle ScholarPubMed
22. Smith, A, Arnold, R, Anderson, RH, et al. Anomalous origin of the left coronary artery from the pulmonary trunk: anatomic findings in relation to pathophysiology and surgical repair. J Thorac Cardiovasc Surg 1989; 98: 16–24.CrossRefGoogle ScholarPubMed
23. Kattach, H, Anastasiadis, K, Jin, XY, Dillai, R. Two-conduit repair for anomalous origin of the left coronary artery from the pulmonary artery in an adult. J Thorac Cardiovasc Surg 2004; 128: 641–642.CrossRefGoogle ScholarPubMed
24. Kitamura, S, Kawachi, K, Nishii, T, et al. Internal thoracic artery grafting for congenital coronary malformations. Ann Thorac Surg 1992; 53: 513–516.CrossRefGoogle ScholarPubMed