Eur J Cardiothorac Surg 2003;23:851-852
© 2003 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 technique
Christian Schreiber*,
Rüdiger Lange
Clinic for Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, 80637 Munich, Germany
Received 16 December 2002;
accepted 27 January 2003.
* Corresponding author. Tel.: +49-89-1218-4111; fax: +49-89-1218-4113
e-mail: schreiber{at}dhm.mhn.de
Key Words: ALCAPA • Dual-coronary system
Ando et al. [1] describe their operative experience of surgical repair for anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).
Still, we feel, for various reasons, that a number of issues require clarification:
- The authors report on their experience in only 13 patients with a median follow-up of 36 months. In respect to the current literature, not only the total number of patients, but also the time of follow-up is rather small. Lambert et al. [2], for example, have elaborated their results on 39 patients followed from 1 month to 13.7 years and Isomatsu et al. [3] report on 29 patients with a mean follow-up 100±57 months.
- The concept of establishing a dual-coronary system is widely approved since the 1980s and not, as the authors put it, ‘more recently...accepted as the procedure of choice’. The authors describe their application of the trapdoor technique. But also this is not new – direct implantation of the left coronary artery (and its modifications) were described previously [4–8]. Experiences with the arterial switch operation have helped to establish this technique worldwide.
In conclusion, instead of elaborating on well-known surgical techniques, it seems to be more important to determine, in the future, the regional myocardial flow reserve in survivors with ALCAPA and its unique underlying pathology (i.e. endocardial and subendocardial fibrosis, damage to the papillary muscles, patchy myocardial necrosis, dilatation of the ventricle, mitral incompetence, left coronary artery (LCA) hypoplasia of the media, ostial stenosis and hypoplasia of the right coronary artery (RCA)). Therefore, large cohorts of long-term survivors need to be investigated. Flow abnormalities could additionally be related to operative techniques, including also subclavian-LCA anastomosis or aortocoronary bypass, timing of repair, and finally patients' exercise performance.
References
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