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Li H, Wang H, Lin Y, Rui L, Li S. Profile and early outcomes of surgical reconstruction of coronary artery atresia in children. Eur J Cardiothorac Surg 2021; 61:580-586. [PMID: 34459900 DOI: 10.1093/ejcts/ezab319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/06/2021] [Accepted: 05/30/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Coronary artery atresia is a rare coronary artery anomaly in children and has a high rate of misdiagnosis. We aimed to summarize the profile and early outcomes after the surgical reconstruction of coronary artery atresia in children. METHODS A retrospective analysis was performed in 12 consecutive patients with coronary artery atresia who were admitted to the Department of Paediatric Cardiac Surgery of Fuwai Hospital between October 2016 and September 2020. Ten patients underwent surgical reconstruction of the coronary artery with the pulmonary artery anterior wall, and 8 patients underwent concomitant mitral valvuloplasty. RESULTS There were 6 females and 6 males, with an age of 1.75 years [interquartile range (IQR), 1.0-3.5] and weight of 10.0 kg (IQR, 8.9-14.75). There were 10 cases of left coronary artery atresia and 2 cases of right coronary artery atresia. All the patients were initially misdiagnosed in the outpatient clinic, but further nonselective coronary angiography confirmed the diagnosis of coronary artery atresia. In all 10 patients with mitral regurgitation, echocardiogram of the mitral valve chordae and papillary muscle revealed ischaemic changes. The clamp time was 89.0 min (IQR, 75.0-101.0), the pump time was 126.0 min (IQR, 119.0-132.0) and the intensive care unit stay time was 1.5 days (IQR, 1.0-3.0). No perioperative deaths were noted. After 9.5 months (IQR, 5.5-13.5) of follow-up, 2 patients with fractional shortening that significantly decreased to 14.1% and 14.8% died and 1 patient had moderate pericardial effusion that improved after treatment with oral diuretics. Coronary artery ultrasound and enhanced computed tomography showed a patent main coronary artery in all the patients. CONCLUSIONS Coronary artery atresia in children is often associated with mitral regurgitation, and mitral valve chordae and papillary muscle exhibit ischaemic changes. Coronary artery reconstruction is safe and effective in children with coronary artery atresia.
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Affiliation(s)
- Hanmei Li
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, CAMS & PUMC, Beijing, China
| | - Hailing Wang
- Department of Anesthesiology, National Center for Cardiovascular Disease and Fuwai Hospital, CAMS & PUMC, Beijing, China
| | - Ye Lin
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, CAMS & PUMC, Beijing, China
| | - Lu Rui
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, CAMS & PUMC, Beijing, China
| | - Shoujun Li
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, CAMS & PUMC, Beijing, China
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Lampropoulos K, Kavouras C, Charitos C. Left main reconstruction as an alternative method to CABG after primary PCI complication. Indian Heart J 2015; 67:259-61. [PMID: 26138184 DOI: 10.1016/j.ihj.2015.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 03/16/2015] [Accepted: 03/29/2015] [Indexed: 10/23/2022] Open
Abstract
Left main coronary artery disease is rare, accounting for 1% of all coronary artery disease and traditionally, is treated by coronary artery bypass grafting. We report our experience and five years follow up, after a coronary osteal surgical plasty in a young man who referred to our center with an anterior myocardial infarction.
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Affiliation(s)
- Konstantinos Lampropoulos
- Department of Cardiology, Catheterization Laboratory, Evaggelismos General Hospital of Athens, Greece.
| | - Charalampos Kavouras
- Department of Cardiology, Catheterization Laboratory, Evaggelismos General Hospital of Athens, Greece
| | - Christos Charitos
- Department of Cardiothoracic Surgery, Evaggelismos General Hospital of Athens, Greece
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Jeong JH, Lee WY, Kim EJ, Cho SW, Kim KI, Kim HS. Long-term results of surgical angioplasty for left main coronary artery stenosis: 18-year follow-up. J Cardiothorac Surg 2015; 10:6. [PMID: 25595512 PMCID: PMC4299293 DOI: 10.1186/s13019-015-0209-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to determine the long-term outcomes of surgical angioplasty for left main coronary artery (SA-LMCA) stenosis. Methods We retrospectively analyzed data from 24 consecutive patients (mean age, 55 years; male/female, 12/12) who underwent a surgical angioplasty for the left main coronary artery (LMCA) stenosis at our institution between 1995 and 2002. We used autologous pericardium in 7 patients and bovine pericardium in 17 patients as a patch. We evaluated the late mortality and major adverse cardiac events (MACE) rate. Results There was no operative mortality. Control coronary angiography exhibited wide open and funnel-shaped LMCA in all patients. One patient was lost to follow-up. During the mean follow-up of 167 months, there were 3 sudden cardiac deaths, 4 non-cardiac related deaths, and 9 MACE with one death at reoperation. The Kaplan-Meier method identified freedom from cardiac death in 95.7, 87.0, and 82.4% of the patients, and freedom from MACE in 91.3, 69.6, and 57.7% of the patients at 5, 10, and 15 years, respectively. Conclusions This study demonstrated that the long-term outcomes of SA-LMCA with a pericardial patch are acceptable compared to those of coronary artery bypass grafting, despite the controversy over the indications and the patch material used.
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Affiliation(s)
- Jae Han Jeong
- Department of Cardiothoracic Surgery, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796, Koera.
| | - Won Yong Lee
- Department of Cardiothoracic Surgery, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796, Koera.
| | - Eung-Joong Kim
- Department of Cardiothoracic Surgery, Hallym University Dongtan Sacred Heart Hospital, Seoku-dong, Hwaseong-si, Gyeonggi-do, 445-907, South Korea.
| | - Sung Woo Cho
- Department of Cardiothoracic Surgery, Hallym University Gangdong Sacred Heart Hospital, Gil-dong, Gangdong-gu, Seoul, 134-701, South Korea.
| | - Kun Il Kim
- Department of Cardiothoracic Surgery, Hallym University Dongtan Sacred Heart Hospital, Seoku-dong, Hwaseong-si, Gyeonggi-do, 445-907, South Korea.
| | - Hyoung Soo Kim
- Department of Cardiothoracic Surgery, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796, Koera.
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Terada T, Sakurai H, Nonaka T, Sakurai T, Sugiura J, Taneichi T, Ohtsuka R. A successful patch angioplasty with auto-pulmonary wall for congenital coronary left main trunk occlusion in a young child. Gen Thorac Cardiovasc Surg 2013; 63:660-3. [PMID: 24113996 DOI: 10.1007/s11748-013-0330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022]
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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Affiliation(s)
- Takafumi Terada
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan.
| | - Hajime Sakurai
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
| | - Toshimichi Nonaka
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
| | - Takahisa Sakurai
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
| | - Junya Sugiura
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
| | - Tetsuyoshi Taneichi
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
| | - Ryohei Ohtsuka
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
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Harling L, Sepehripour AH, Ashrafian H, Lane T, Jarral O, Chikwe J, Dion RAE, Athanasiou T. Surgical patch angioplasty of the left main coronary artery. Eur J Cardiothorac Surg 2012; 42:719-27. [PMID: 22677352 DOI: 10.1093/ejcts/ezs324] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Isolated ostial stenosis of the left main coronary artery (LMCA) is rare, occurring in <1% of the patients undergoing coronary angiography. Surgical patch angioplasty (SPA) offers an alternative to conventional coronary artery bypass grafting (CABG) in such cases and is advantageous in restoring more physiological myocardial perfusion, maintaining ostial patency and preserving conduit material. However, a number of early technical failures and high perioperative mortality have limited the generalized uptake of this procedure, and only recently have advances in myocardial protection and novel surgical approaches to the LMCA resulted in a resurgence of the technique. A systematic literature search identified 45 studies incorporating 478 patients undergoing SPA. A variety of patch materials were used, including the pericardium, saphenous vein and internal mammary and pulmonary arteries. Patients were followed up for a mean of 54.4 months. The 30-day mortality was 1.7% and cardiac specific mortality 3.3% at last follow-up. Encouragingly, 92.4% of reported cases (n = 182) showed complete angiographic patency at last follow-up. Our results indicate that SPA may be a viable alternative to CABG in the surgical management of isolated ostial LMCA stenosis. However, no randomized trials have been performed, and it is clear that careful patient selection is essential in minimizing morbidity and mortality in the short- and long-term. Further research is required to allow a direct comparison of SPA to techniques with a more substantial evidence base such as CABG and percutaneous coronary intervention, and to define the optimal patch graft material, elucidating that any beneficial effects arterial patches may have on long-term patency.
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Affiliation(s)
- Leanne Harling
- Department of Surgery and Cancer , Imperial College Healthcare NHS Trust, Imperial College London, London, UK.
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