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. 2014 Jun;47(3):220-4.
doi: 10.5090/kjtcs.2014.47.3.220. Epub 2014 Jun 5.

An alternative surgical technique for repair of anomalous origin of the left coronary artery from the pulmonary artery

Young-Su Kim  1 , Mina Lee  1 , Yang Hyun Cho  1 , Ji-Hyuk Yang  1 , Tae-Gook Jun  1
Affiliations

An alternative surgical technique for repair of anomalous origin of the left coronary artery from the pulmonary artery

Young-Su Kim et al. Korean J Thorac Cardiovasc Surg. 2014 Jun.

Abstract

Background: For the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA.

Methods: Between October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed.

Results: There was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement.

Conclusion: Our modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA.

Keywords: 1. Coronary vessel anomalies; 2. Bland white Garland syndrome; 3. Replantation; 4. Congenital heart disease.

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Figures

Fig. 1
Fig. 1
(A) The main pulmonary artery is transected above the origin of the LCA. (B) The pulmonary artery flap and aortic trapdoor are designed as shown. RC, right coronary artery; LCA, left coronary artery.
Fig. 2
Fig. 2
(A) The left coronary artery is freed from the pulmonary artery, and the aortic trapdoor is opened anteriorly. (B) The pulmonary artery flap is folded to make a tube-like conduit.
Fig. 3
Fig. 3
(A) The LCA is anastomosed to the aortic trapdoor anteriorly and directly to the aorta posteriorly. (B) The pulmonary artery is repaired with autologous pericardium, and the main pulmonary artery is reconstructed. LCA, left coronary artery; RCA, right coronary artery.
Fig. 4
Fig. 4
Follow-up echocardiography showed enhancing LVEF. LVEF, left ventricular ejection fraction; Preop, preoperative; Postop, postoperative.
Fig. 5
Fig. 5
Follow-up computed tomography angiography was performed 5 years after surgery. It showed good coronary patency.
Fig. 6
Fig. 6
One year later, patient 7 underwent coronary angiography which verified the patent left coronary artery.
See this image and copyright information in PMC

References

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