An alternative technique for transfer of anomalous left coronary artery from the pulmonary trunk in children and adults using autogenous aortic and pulmonary arterial flaps

Abstract

The potential benefits of this modification of the trapdoor technique are excellent operative exposure, use of autogenous and viable tissue capable of further growth, avoidance of injury to the aortic and pulmonary valvar apparatus and production of obstruction within the right ventricular outflow tract, complete elimination of use of pericardium for augmentation of the neo-aortic tube, achievement of the anastomosis with correct angling and length, and the possibility of implantation in all patients, including adults, regardless of the distance from the aorta or the coronary arterial configuration.

Aortic Implantation for Anomalous Connection of the Coronary Artery to the Pulmonary Artery in Older Children and Adults

“…However, only very few studies have investigated the application of aortic implantation to treat ACAPA in older children and adults. 11,12,19,20 Aortic implantation connects the anomalously connected left/right coronary artery or the branches of the left coronary artery to the ascending aorta. For some cases with ALCAPA, the distance between the opening of the anomalously connected coronary artery to the aorta is relatively long, and the coronary artery is connected to the right pulmonary sinus, nonfacing sinus, or left pulmonary sinus, and the pulmonary artery wall could be used to suture tubes with different length to anastomose to the aorta.…”

“…For some cases with ALCAPA, the distance between the opening of the anomalously connected coronary artery to the aorta is relatively long, and the coronary artery is connected to the right pulmonary sinus, nonfacing sinus, or left pulmonary sinus, and the pulmonary artery wall could be used to suture tubes with different length to anastomose to the aorta. 8,10,11,20 Tubular anastomosis may reduce the vascular tension, ensure the sufficient perfusion of the coronary artery, and reduce the incidence of late anastomotic stenosis.…”

Successful surgical osteoplasty of the left main coronary artery with concomitant mitral valve replacement and tricuspid annuloplasty

“…Encouraged by our preliminary results of coronary ostial reconstruction using autogenous pulmonary arterial flaps in 5 patients of ostial noncalcified LMCA stenosis aged <60 years and in patients with anomalous origin of left coronary artery from pulmonary artery,[ 6 ] we gradually broadened our indication applying the technique in this patient requiring LMCA ostial reconstruction, concomitant mitral valve replacement (MVR), and tricuspid annuloplasty. For optimal exposure of this aspect of the aorta and LMCA, various ingenious approaches have been described, namely, the posterior, anterior, transaortic, and transpulmonary approaches.…”

Use of the Batista Procedure to Discontinue Bypass Following Aortic Reimplantation of an Anomalous Left Coronary Artery

“…Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an uncommon congenital anomaly (1/300.000 live births), which usually presents in infancy with congestive heart failure. Direct reimplantation into the aortic sinus is the technique of choice 1 . As a bridge to recovery of left ventricular (LV) function in the postoperative setting, the use of cardiac mechanical support plays an integral part in the surgical treatment of these patients.…”