Anomalous origin of the left coronary artery from the pulmonary artery: A new operative technique

Late surgical correction of anomalous left coronary artery from pulmonary trunk in children, using autogenous aortic and pulmonary endotheliazed tube

“…The criticism of this procedure is still the need for dissection of the main branches of the coronary artery, for its approach to the ascending aorta, often hindered by the presence of tortuous coronary collaterals. Similar procedures have been published by Tashiro et al [3] in 1992 and Von Son et al [4] in 1997. Katsumata et al [5] in 1999 and Murthy et al [6] in 2001, based on initial experience stretching the left coronary artery, now with aortic and pulmonary flaps, larger in width and length, built autogenous arterial conduits or tubs, to reimplant the left coronary artery originating from the left posterior sinus of the pulmonary valve without tension and without dissection of the main coronary branches.…”

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

“…Creation of a dual coronary arterial system in the preferred option for surgical repair in patients with anomalous origin of the left coronary artery from the pulmonary trunk. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] It eliminates the ''steal'' phenomenon, and restores physiological antegrade flow to the ischaemic left ventricular myocardium. Available surgical procedures include direct coronary arterial re-implantation, the intrapulmonary tunnel repair, prolongation of flaps of pulmonary arterial wall with or without anastomosis to the right subclavian artery, left sulclavian artery-to-left coronary artery anastomosis, and ligation with saphenous venous interposition, and anastomosis of the left internal thoracic artery to the left anterior interventricular artery.…”

“…[1][2][3][4][5][6][7][8][9][10] In these situations, it has been proposed to interpose a free segment of the subclavian artery; 11 to create an intrapulmonary tunnel; 6 or to prolong flaps of pulmonary arterial wall with or without anastomosis to the right subclavian artery. 3,9,[12][13][14][15] We present here our experience with the modification of the trapdoor technique, wherein the anomalous left coronary artery is detached from the pulmonary arterial sinus, and combined autogenous aortic and pulmonary arterial flaps are used to augment its length.…”

Correção da origem anômala de artéria coronária esquerda com insuficiência mitral e hemólise mecânica

“…On opening the left atrium, significant mitral annular dilation was evidenced with lengthening of the chords and slight prolapse. Plicature of the two commissures was performed according to the Reed technique [6] using four fragments of bovine pericardium. The sternum was only closed five days after the procedure.…”

“…In respect to the mitral valve annuloplasty, the ring was placated near the commissures according to the Reed technique [6], using four strips of bovine pericardium to reinforce the sutures. With the progressive improvement of the left ventricular function, there was concomitantly an increase in the mechanic hemolysis caused by a regurgitation flow in the commissural region leading to high serum levels of bilirubin.…”