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Towards an anatomically correct repair for anomalous left coronary artery arising from the pulmonary trunk

Published online by Cambridge University Press:  01 August 2008

M. Muneer Amanullah ,
Anthony J. Rostron ,
J. R. Leslie Hamilton ,
Milind P. Chaudhari  and
Asif Hasan
M. Muneer Amanullah
Affiliation:
Division of Congenital Cardiac Surgery and Congenital Cardiology, The Freeman Hospital, Newcastle upon Tyne, United Kingdom
Anthony J. Rostron
Affiliation:
Division of Congenital Cardiac Surgery and Congenital Cardiology, The Freeman Hospital, Newcastle upon Tyne, United Kingdom
J. R. Leslie Hamilton
Affiliation:
Division of Congenital Cardiac Surgery and Congenital Cardiology, The Freeman Hospital, Newcastle upon Tyne, United Kingdom
Milind P. Chaudhari
Affiliation:
Division of Congenital Cardiac Surgery and Congenital Cardiology, The Freeman Hospital, Newcastle upon Tyne, United Kingdom
Asif Hasan*
Affiliation:
Division of Congenital Cardiac Surgery and Congenital Cardiology, The Freeman Hospital, Newcastle upon Tyne, United Kingdom
*
Correspondence to: Mr Asif Hasan, Consultant Cardiothoracic Surgeon, Division of Congenital Cardiac Surgery, Cardiothoracic Centre, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, United Kingdom. Tel: +44 (0)191 233 6161; Fax: +44 (0)191 223 1175; E-mail: asif.hasan@nuth.nhs.uk
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Abstract

Background

Anomalous origin of the left coronary artery from the pulmonary trunk is rare, occurring at an incidence of 1 in 300 000. If not diagnosed and treated early, it is life-threatening. Children with the anomaly usually present in infancy with congestive cardiac failure, and are occasionally referred for cardiac transplant. We investigated the medium term outcome for patients following creation of a two-coronary arterial circulation.

Methods

Between 1992 and 2007, we diagnosed 15 patients seen at our Institution as having anomalous origin of the left coronary artery from the pulmonary trunk. Over a period of 13 years, aortic reimplantation was undertaken in 12 of these patients, who form the studied cohort.

Results

Direct reimplantation was performed in 5 patients. In 3 cases, a tension-free anastomosis was created using a caudally based flap. In another 3 cases, an extended flap was used, while a patch arterioplasty was fashioned in the final patient. There were no deaths. Left ventricular function recovered in all but one of the patients, and all patients had a reduction in the degree of mitral regurgitation.

Conclusions

Among the variety of surgical techniques, transfer of the anomalous left coronary artery to the aorta is the ideal method for long-term patency and adequate blood supply. This can be achieved by creating flaps based on the walls of the pulmonary trunk and aorta, producing a dual coronary arterial supply with no mortality and low morbidity.

Keywords

Anastomosisaortic operationacyanotic congenital cardiac diseasecoronary arterial pathology
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 4 , August 2008 , pp. 372 - 378
Copyright
Copyright © Cambridge University Press 2008

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