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Case Reports
. 2014 Feb;41(1):48-50.
doi: 10.14503/THIJ-12-3112.

Repair of Bland-White-Garland syndrome via a modified technique

Imthiaz Manoly  1 , Dimos Karangelis, Nicola Viola, Marcus Haw
Affiliations
Case Reports

Repair of Bland-White-Garland syndrome via a modified technique

Imthiaz Manoly et al. Tex Heart Inst J. 2014 Feb.

Abstract

Surgically repairing Bland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a challenge if there are variations in the origin of the anomalous artery. We report the successful repair of this congenital abnormality in a 19-year-old woman who presented with an acute anterior myocardial infarction. The anomalous artery originated from the anterior-facing sinus of the pulmonary artery, which precluded typical repair by direct reimplantation or fashioning an intrapulmonary tunnel. We created an extrapulmonary tunnel, using a strip of pulmonary artery anteriorly and an aortic flap posteriorly. Three years postoperatively, the anastomosis was patent and the patient was asymptomatic. Our modified technique might serve as an alternative method during similar surgical circumstances.

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Figures

Fig. 1
Fig. 1
Cardiac magnetic resonance images. A) Axial oblique curved multiplanar reformatted image from a 3-dimensional whole-heart navigator sequence shows the left main stem (LMS) arising from the main pulmonary artery (MPA). The left anterior descending coronary artery (LAD) is substantially dilated. B) Collateral vessels between the right and left coronary arteries are dilated. Ao = aorta
Fig. 2
Fig. 2
A) The dilated left anterior descending coronary artery (LAD) originates from the anterolateral sinus of the pulmonary artery (PA). The right coronary artery (RCA) is dilated. B) The left main button is resected along with a strip of PA, and a strip of aortic wall is resected above the sinotubular junction. C) The strips of PA and aorta are anastomosed to create a sleeve. The PA is repaired with bovine pericardium. D) Bovine pericardium is used to patch the aorta. Ao = aorta; Cx = left circumflex coronary artery; RA = right atrium; RV = right ventricle
Fig. 3
Fig. 3
Postoperative volume-rendered magnetic resonance image from a 3-dimensional whole-heart sequence shows the newly constructed surgical conduit with no narrowing. The right coronary artery (RCA) remains dilated. Ao = aorta; MPA = main pulmonary artery
See this image and copyright information in PMC

Comment in

References

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