WJCD  Vol.2 No.3 , July 2012
Late surgical correction of anomalous left coronary artery from pulmonary trunk in children, using autogenous aortic and pulmonary endotheliazed tube
Author(s) Miguel A. Maluf*
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 ar- tery arises from the left posterior pulmonary sinus. We report the successfully late follow-up of series of patients employing a new technique using combined autogenous aortic and pulmonary endotheliazed tube. Patients and Methods: We have treated 3 patients, aged 2 months, 6 months and 8 months respectively, who presented with anomalous origin of the left coronary artery from the left posterior pulmonary sinus and moderated mitral valve insufficiency by left ventricle dysfunction. We used a trapdoor like coronary artery elongation with autogenous aortic and pulmonary endotheliazed tube to connect the left coronary ostium to ascending aorta, avoiding the mitral valve intervention. Results: There was no early or late death. All patients are in functional class I, with good biventricular function and competent mitral valve at a median follow-up of 94 months, ranged from 108 to 132 months. Postoperative Computerized tomogramphy of aorta in our 1st patient showed good arterial flow, without any distortion. A local and distal stenosis of the left pulmonary artery was observed and submitted to stent treatment. Conclusions: The potential benefits of the trapdoor like and its modification technique are excellent operative exposure. The use of autogenous endothelized tube is a viable tissue capable of further growth, avoidance of injury to the aortic and pulmonary valvar apparatus or production of obstruction within the right ventricular outflow tract.

Cite this paper
Maluf, M. (2012) Late surgical correction of anomalous left coronary artery from pulmonary trunk in children, using autogenous aortic and pulmonary endotheliazed tube. World Journal of Cardiovascular Diseases, 2, 136-140. doi: 10.4236/wjcd.2012.23022.
References
[1]   Vohue, P.R., Tamisier, D., Sidi, D., Vernant, F., Mauriat, P., Pouard, P. and Leca, F. (1992) Anomalous left coronary artery from the pulmonary artery: Results of isolated aortic reimplantation. Annals of Thoracic Surgery, 54, 621-627. doi:10.1016/0003-4975(92)91004-S

[2]   Sese, A. and Omoto, Y. (1992) New technique in the transfer of an anomalously originated left coronary artery to the aorta. Annals of Thoracic Surgery, 53, 527-529. doi:10.1016/0003-4975(92)90290-K

[3]   Tashiro, T., Todo, K., Hamta, Y., Yasunaga, H., Nagata, M. and Nakamura, M. (1993) Anomalous origin of the left coronary artery from the pulmonary artery: New operative technique. Journal of Thoracic and Cardiovascular Surgery, 106, 718-722.

[4]   Von Son, J.A. and Mohr, F.W. (1997) Repair of anomalous connection of the left coronary artery to the pulmonary artery using native aorta and pumnonary tissue flaps. European Journal Cardio-Thoracic Surgery, 12, 322-329. doi:10.1016/S1010-7940(97)00124-3

[5]   Katsumata, T. and Westaby, S. (1999) Anomalous left coronary artery from the pulmonary artery: A simple method for aortic implantation with autogenous arterial tissue. Annals of Thoracic Surgery, 68, 1090-1011. doi:10.1016/S0003-4975(99)00761-4

[6]   Murthy, K.S., Krishnanaik, S., Mohanty, S.R., Varghese, R. and Cherian, K.M. (2001) A new repair for anomalous left coronary artery. Annals of Thoracic Surgery, 71, 1384- 1386. doi:10.1016/S0003-4975(00)02506-6

[7]   Maluf, M.A., Mangia, C.M., Diogenes, M.S., Carvalho, A.C. and Buffolo, E. (2004) Anomalous coronary artery from pulmonary artery: Autogenous arterial tube for aortic implantation. Journal of Cardiovascular Surgery, 45, 577-579.

 
 
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