Journal Article

Creation of a dual-coronary system for anomalous origin of the left coronary artery from the pulmonary artery utilizing the trapdoor flap method

Makoto Ando, Roger B.B. Mee, Brian W. Duncan, Jonathan J. Drummond-Webb, Shivaprakash G. Seshadri and C. Igor Mesia

in European Journal of Cardio-Thoracic Surgery

Published on behalf of European Association for Cardio-Thoracic Surgery

Volume 22, issue 4, pages 576-581
Published in print October 2002 | ISSN: 1010-7940
Published online October 2002 | e-ISSN: 1873-734X | DOI: https://dx.doi.org/10.1016/S1010-7940(02)00407-4
Creation of a dual-coronary system for anomalous origin of the left coronary artery from the pulmonary artery utilizing the trapdoor flap method

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  • Anatomy
  • Professional Development in Medicine
  • Cardiothoracic Surgery
  • Cardiovascular Medicine
  • History of Medicine

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Objective: Results of the repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) have improved. Direct implantation of the anomalous coronary artery into the ascending aorta establishes a dual-coronary system and is the goal of current surgical approaches. We report the development of our surgical technique for ALCAPA. Methods: Between September 1993 and December 2000, 13 patients underwent surgery for ALCAPA. There were four males and nine females. Ages ranged from 1 month to 25 years (median=3.9) and weight ranged from 2.6 to 102 kg (median=16.8). One patient had previously undergone an operative procedure at an outside institution. Results: Direct implantation of the anomalous coronary artery into the ascending aorta was feasible in 12 of 13 patients. In situ transfer was performed in one patient with an intramural coronary artery. The first case in the series required an intrapulmonary baffle reconstruction (Takeuchi procedure) because the coronary artery arose remotely from the ascending aorta from the left-anterior sinus of the PA. For coronary transfer, a trapdoor flap was created on the ascending aorta for the implantation of the coronary button and the sinus defect in the main PA was augmented with a pericardial patch. The left ventricular (LV) shortening fraction was improved from a median value of 27% (range 12–36%) preoperatively to 33% (range 24–45%) in the immediate postoperative period (P=0.004). The LV end-diastolic dimension decreased from a median value of 36 mm (range 22–70 mm) preoperatively to 29 mm (range 19–56 mm) in the immediate postoperative period (P=0.004). There has been no mortality or reoperation during a median follow-up of 36 months. Conclusions: Using a standard technique, direct implantation of the anomalous coronary artery into the ascending aorta was achieved in all cases but one. At intermediate follow-up, LV function had improved by echocardiography. No postoperative mechanical circulatory support was required in any of these patients. This operative technique is reproducible and is applicable to the majority of patients with ALCAPA.

Keywords: Anomalous origin of the left coronary artery from the pulmonary artery; Direct implantation; Dual-coronary system; Bland-White-Garland syndrome

Journal Article.  2928 words.  Illustrated.

Subjects: Anatomy ; Professional Development in Medicine ; Cardiothoracic Surgery ; Cardiovascular Medicine ; History of Medicine

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