Abstract
Congenital occlusion of the left main coronary trunk is a life-threatening abnormality, and its optimal management remains controversial. This report describes a case of successful patch angioplasty with auto-pulmonary artery for a 12-year-old boy with congenital left main trunk occlusion. We divided the main pulmonary artery, harvested a pulmonary artery wall strip, and performed patch angioplasty of the occluded left main trunk ostium. We were able to clearly expose the left main trunk behind the pulmonary artery because the obstruction was divided for the patch material. The postoperative course was uneventful, and coronary angiography at 4 months after surgery showed excellent patency of the left main trunk. The auto-pulmonary arterial wall was easy to handle during angioplasty, and its favorable durability has been established both in the Ross procedures and in an arterial switch procedure. Therefore, we conclude that patch angioplasty using a piece of the pulmonary arterial wall represents a good alternative to conventional coronary artery bypass grafting.
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References
Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation. 2007;115(10):1296–305.
Bonnet D, Bonhoeffer P, Sidi D, Kachaner J, Acar P, Villain E, Vouhe PR. Surgical angioplasty of the main coronary arteries in children. J Thorac Cardiovasc Surg. 1999;117:352–7.
Musiani A, Cernigliaro C, Sansa M, Maselli D, Da Gasperis CD. Left main coronary artery atresia: Literature review and therapeutical considerations. Eur J Cardiothorac Surg. 1997;11(3):505–14.
Tanyanan T, Brian PO, Alan HS, Carlos EA. Left main coronary atresia. J Card Surg. 2013;28:37–46.
Harling L, Sepehripour AH, Ashra H, Lane T, Jarral O, Chikwe J, et al. Surgical patch angioplasty of the left main coronary artery. Eur J Cardiothorac Surg. 2012;42:719–27.
Molina JE. 10 plus-years follow-up after patch angioplasty of the left main coronary artery. Int J Angiol. 2011;29(3):143–7.
Raanani E, Kogan A, Shapira Y, Sagie A, Kornowsky R, Vidne BA. Surgical reconstruction of the left main coronary artery: fresh autologous pericardium or saphenous vein patch. Ann Thorac Surg. 2004;78:1610–3.
Martinovic I, Greve H. Surgical reconstruction of the left main coronary artery with patch-angioplasty. J Cardiothorac Surg. 2011;6:24.
Liska J, Jönsson A, Lockowandt U, Herzfeld I, Gelinder S, Franco-Cereceda A. Arterial patch angioplasty for reconstruction of proximal coronary artery stenosis. Ann Thorac Surg. 1999;68:2185–90.
Bilal MS, Gurer O, Tanrikulu N, Kirbas A. Repair of left main coronary ostial stenosis using autologous aortic tissue. J Card Surg. 2011;26(6):586–90.
Malyshev M, Gladyshev I, Safuanov A, Siniukov D, Borovikov D, Rostovykh N. Surgical angioplasty of the left main coronary artery and/or proximal segment of the right coronary artery by pulmonary autograft patch. Eur J Cardiothorac Surg. 2004;25:21–5.
Kitamura S, Seki T, Kawauchi K, Morita R, Kawata T, MIzuguchi K, et al. Excellent patency and growth potential of internal mammary artery grafts in pediatric coronary artery bypass surgery: new evidence for a “live” conduit. Circulation. 1988;78(suppl I):129–39.
Kitamura S, Tsuda E, Kobayashi J, Nakajima H, Yoshikawa Y, Yagihara T, et al. Twenty-five-year outcome of pediatric coronary artery bypass surgery for Kawasaki disease. Circulation. 2009;120:60–8.
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Terada, T., Sakurai, H., Nonaka, T. et al. A successful patch angioplasty with auto-pulmonary wall for congenital coronary left main trunk occlusion in a young child. Gen Thorac Cardiovasc Surg 63, 660–663 (2015). https://doi.org/10.1007/s11748-013-0330-5
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DOI: https://doi.org/10.1007/s11748-013-0330-5