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

摘要

Background: Direct re-implantation of an anomalous left coronary artery into the aorta is the preferred surgical option for creating a dual coronary arterial system in patients in whom the anomalous artery originated from the pulmonary trunk. This technique, however, is applicable only when the anomalous ar- tery arises from the left posterior pulmonary sinus. We report the successfully late follow-up of series of patients employing a new technique using combined autogenous aortic and pulmonary endotheliazed tube. Patients and Methods: We have treated 3 patients, aged 2 months, 6 months and 8 months respectively, who presented with anomalous origin of the left coronary artery from the left posterior pulmonary sinus and moderated mitral valve insufficiency by left ventricle dysfunction. We used a trapdoor like coronary artery elongation with autogenous aortic and pulmonary endotheliazed tube to connect the left coronary ostium to ascending aorta, avoiding the mitral valve intervention. Results: There was no early or late death. All patients are in functional class I, with good biventricular function and competent mitral valve at a median follow-up of 94 months, ranged from 108 to 132 months. Postoperative Computerized tomogramphy of aorta in our 1st patient showed good arterial flow, without any distortion. A local and distal stenosis of the left pulmonary artery was observed and submitted to stent treatment. Conclusions: The potential benefits of the trapdoor like and its modification technique are excellent operative exposure. The use of autogenous endothelized tube is a viable tissue capable of further growth, avoidance of injury to the aortic and pulmonary valvar apparatus or production of obstruction within the right ventricular outflow tract.