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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: ujjwalchow@rediffmail.com, ujjwalchowdhury@gmail.com
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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

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