Chowdhury Ujjwal K, Kothari Shyam S, Patel Chetan D, Mishra Anand K, Jagia Priya, Subramaniam Ganapathy K, Pradeep Kizakke K, Govindappa Raghu M
Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India.
Cardiol Young. 2008 Apr;18(2):165-76. doi: 10.1017/S1047951107001898. Epub 2008 Feb 14.
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 artery arises from the right posterior pulmonary sinus. We report a new technique for re-implantation using combined autogenous aortic and pulmonary arterial flaps in situations when a direct connection was not possible.
We have treated 4 patients, aged 3 months, 6 months, 18 months, and 27 years respectively, who presented with anomalous origin of the left coronary artery from the left posterior pulmonary sinus. We used our proposed technique for transfer because lack of coronary arterial length, diminished vessel elasticity, and extensive collaterals around the pulmonary sinuses prevented direct attachment.
There was no early or late death. Postoperatively, all patients are in functional class I, with good biventricular function at a median follow-up of 74 months, with a range from 9 to 96 months. Postoperative coronary angiography in our 4th patient showed good arterial flow, without any distortion.
The potential benefits of this modification of the trapdoor technique are excellent operative exposure, use of autogenous and viable tissue capable of further growth, avoidance of injury to the aortic and pulmonary valvar apparatus and production of obstruction within the right ventricular outflow tract, complete elimination of use of pericardium for augmentation of the neo-aortic tube, achievement of the anastomosis with correct angling and length, and the possibility of implantation in all patients, including adults, regardless of the distance from the aorta or the coronary arterial configuration.
对于左冠状动脉异常起源于肺动脉干的患者，将异常的左冠状动脉直接重新植入主动脉是创建双冠状动脉系统的首选手术方式。然而，该技术仅适用于异常动脉起源于右后肺动脉窦的情况。我们报告一种在无法进行直接连接时使用自体主动脉瓣和肺动脉瓣联合瓣片进行重新植入的新技术。
我们分别治疗了4例患者，年龄分别为3个月、6个月、18个月和27岁，均表现为左冠状动脉起源于左后肺动脉窦。由于冠状动脉长度不足、血管弹性降低以及肺动脉窦周围广泛的侧支循环妨碍直接附着，我们采用了我们提出的转移技术。
无早期或晚期死亡。术后，所有患者心功能均为I级，在中位随访74个月（范围为9至96个月）时双心室功能良好。我们的第4例患者术后冠状动脉造影显示动脉血流良好，无任何扭曲。
这种改良活板门技术的潜在益处包括手术暴露极佳、使用能够进一步生长的自体且有活力的组织、避免损伤主动脉瓣和肺动脉瓣装置以及右心室流出道内产生梗阻、完全无需使用心包来扩大新主动脉管、以正确的角度和长度实现吻合，以及有可能对所有患者（包括成人）进行植入，而不论其与主动脉的距离或冠状动脉形态如何。
