Coronary artery grafting in infants
Mr Gopal1, S Maskari, S Zacharias
1Department of Cardiothoracic Surgery, The Royal Hospital, Po Box 1331, Postal Code 111, The Sultanate of Oman.
Insights
Coronary artery bypass grafting (CABG) in infants is a rare but potentially life-saving procedure. Successful CABG in two infants demonstrated its feasibility for critical cardiac conditions when other options are exhausted.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Infant Cardiac Interventions
Background:
- Coronary artery bypass grafting (CABG) in infants is infrequently performed due to technical challenges and unknown outcomes.
- The small caliber of infant coronary and graft arteries presents significant surgical hurdles.
- Historically, CABG in infants has been avoided due to limited data on efficacy and safety.
Observation:
- Two infant cases requiring CABG as a life-saving intervention are presented.
- Case 1 involved post-arterial switch operation right coronary artery (RCA) stenosis, treated with right internal mammary artery (RIMA) bypass.
- Case 2 involved post-ALCAPA repair left coronary artery occlusion and mitral regurgitation, treated with left internal mammary artery (LIMA) to LAD bypass and mitral valve repair.
Findings:
- Successful CABG using internal mammary arteries as grafts was achieved in both infants.
- Both patients experienced dramatic improvement in hemodynamic status and clinical condition post-operatively.
- The procedures addressed critical coronary stenoses and occlusions leading to low cardiac output.
Implications:
- CABG can be a viable, albeit technically demanding, life-saving option in select infant cardiac surgical emergencies.
- Internal mammary arteries demonstrate utility as bypass grafts in infant coronary artery revascularization.
- Further research into long-term outcomes of infant CABG is warranted to establish its role in pediatric cardiac surgery.
Background:
Coronary artery bypass grafting (CABG) with cardiac vale repair is an uncommon surgery in infants. CABG is technically demanding in infants due to the small size not only of the coronary arteries but also the potential graft arteries. The short and long-term outcome of surgery is not known and thus has largely been avoided.
Results:
We report the case histories of two infants in whom CABG was undertaken successfully as a life-saving measure. Case 1: This infant needed an arterial switch operation after which the right coronary artery (RCA) was stenosed resulting in low cardiac output. After the right internal mammary artery (RIMA) was used to anastamose the RCA, the hemodynamic status improved drastically. Case 2: This infant underwent surgical correction for Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA). Postoperatively, she was in low cardiac output. She was found to have an occluded left coronary artery and mitral regurgitation (MR). After she underwent left internal mammary artery (LIMA) to Left Anterior Descending (LAD) anastamosis and mitral valve repair, the clinical condition improved dramatically.
Conclusion:
CABG is an uncommon operation in infants. This surgery is technically difficult. The long term results are not known and there are very few reports for the same. Though such an operation is best avoided, it can be used as a desperate life saving measure.
