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Evolution of Surgical Strategies for Anomalous Left Coronary Artery

Department of Pediatric Cardiac Surgery Institute of Cardiovascular Diseases Madras Medical Mission Chennai, Tamil Nadu, India
For reprint information contact: Smruti Ranjan Mohanty, MCh Tel: 91 44 656 5961 Fax: 91 44 656 5510 email: mmmbits{at}giasmd01.vsnl.net.in Department of Pediatric Cardiac Surgery, Institute of Cardiovascular Diseases, Madras Medical Mission, 4A Dr. J Jayalalitha Nagar, Mogappair, Chennai, Tamil Nadu 600050, India.

Between 1980 and 2000, 18 patients aged 3 months to 60 years underwent repair of an anomalous left coronary artery from the pulmonary artery. Up to 1993, 8 patients were managed by subclavian artery turndown (4), coronary artery revascularization with ligation of the anomalous left coronary artery (3), or ligation of the anomalous left coronary artery alone (1). From 1994 to 1999, 6 patients underwent Takeuchi's repair. Great arterial wall tube interposition was used in the latest 4 patients. Concomitant mitral valve procedures were required in 4 patients. There were 3 early postoperative deaths (16.7%), and 1 patient who underwent subclavian artery turndown and mitral valve replacement died of bacterial endocarditis 3 months postoperatively. One patient had a tunnel leak at 6 months postoperatively, which was closed successfully; another developed significant right ventricular outflow obstruction and is awaiting surgery. Early two-coronary repair using the great arterial wall tube interposition technique looks promising.