Pulmonary Root Mobilization and Modified Lecompte Maneuver for Transseptal Course of the Left Main Coronary Artery

Abstract

Intraconal or transseptal course of the left main coronary artery is a rare form of coronary artery anomalies which has been linked to sudden death. We present details of the surgical technique that we used to address this challenging anomaly in two cases.

Not So Stable Angina: Single Coronary Artery Disease

“…The American Heart Association also recommended surgery in SCA with typical ischemic symptoms and positive stress imaging as a class I recommendation and a class IIa for those without symptoms [ 3 ]. However, the type of surgery recommended for the patient is still debatable because the benefit of surgery on long-term outcomes is still unclear [ 6 ]. The coronary artery bypass graft is not recommended in a patient without significant stenosis due to the risk of competitive flow from native vessels causing graft failure.…”

“…Surgical correction is more commonly performed in SCA with interarterial and intraseptal courses. Reported surgical techniques for SCA with RII-S modified Lipton’s classification include pulmonary root mobilization and modified Lecompte maneuver; supraarterial myotomy by unroofing the artery into the right ventricular cavity; unroofing of the intraseptal LCA by circumferentially transecting and extending the right ventricular infundibulum using autologous pericardium [ 6 - 8 ]. In this case, simple unroofing of LM from the interventricular septum without pulmonary artery relocation was performed with a good outcome.…”

Transseptal coronary artery—a pictorial review

“…Surgical repair would be indicated to relieve the ischemia in patients with cardiovascular symptoms and evidence of ischemia [ 10 ]. Coronary artery bypass graft (CABG) or mobilization of the pulmonary root and incising the overlying muscle bridge with translocation of the right pulmonary artery are known surgical techniques for the transseptal course [ 3 , 11 ]. A newer surgical technique with a transconal approach includes transection of the RVOT, unroofing the septal course of the LMCA or LAD, followed by repair of the posterior wall of RVOT with autologous pericardial patch [ 2 , 3 ] (Figs.…”