HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ando, M. Articles by Mesia, C. I. Search for Related Content PubMed PubMed Citation Articles by Ando, M. Articles by Mesia, C. I. Related Collections Congenital - acyanotic Great vessels Myocardial infarction

Eur J Cardiothorac Surg 2002;22:576-581
© 2002 Elsevier Science NL

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

Pediatric and Congenital Heart Surgery, Cleveland Clinic Children's Hospital, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA

Received 18 August 2001; received in revised form 31 May 2002; accepted 26 June 2002.

* Corresponding author. Tel.: +1-216-445-7833; fax: +1-216-445-3692
e-mail: meer{at}ccf.org

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.

Key Words: Anomalous origin of the left coronary artery from the pulmonary artery • Direct implantation • Dual-coronary system • Bland-White-Garland syndrome

This article has been cited by other articles:

				Y. Ando, H. Kado, M. Masuda, T. Nakano, K. Hinokiyama, A. Shiose, and M. Kajimoto "Spiral-Cuff" Technique for Repair of Anomalous Left Coronary Artery From the Pulmonary Artery Ann. Thorac. Surg., August 1, 2008; 86(2): 667 - 668. [Abstract] [Full Text] [PDF]

				P. Modi, Q. Chen, T. Murphy, and A. Pawade Repair of Anomalous Left Coronary Artery from the Right Pulmonary Artery Asian Cardiovasc Thorac Ann, June 1, 2008; 16(3): 252 - 253. [Abstract] [Full Text] [PDF]

				A. Korach, P. Menon, M. Dhadly, K. E. Raby, R. J. Shemin, and O. M. Shapira Anomalous Left Main Coronary Artery From the Main Pulmonary Artery in an Elderly Patient Ann. Thorac. Surg., December 1, 2006; 82(6): 2285 - 2287. [Abstract] [Full Text] [PDF]

				R. R. Guerrero, J. L. Wilkinson, and C. P. Brizard Reconstruction of left main coronary artery with subclavian artery free graft in an infant Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 927 - 929. [Abstract] [Full Text] [PDF]

				G. Michielon, D. Di Carlo, G. Brancaccio, P. Guccione, E. Mazzera, A. Toscano, and R. M. Di Donato Anomalous coronary artery origin from the pulmonary artery: correlation between surgical timing and left ventricular function recovery Ann. Thorac. Surg., August 1, 2003; 76(2): 581 - 588. [Abstract] [Full Text] [PDF]

				C. Schreiber and R. Lange Creation of a dual-coronary system for anomalous origin of the left coronary artery from the pulmonary artery utilizing the trapdoor flap technique Eur. J. Cardiothorac. Surg., May 1, 2003; 23(5): 851 - 852. [Full Text] [PDF]