Redo coronary bypass grafting for congenital left main coronary atresia: a case report
Shin Yajima1, Koichi Toda2, Hiroyuki Nishi2
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan. s-yajima@surg1.med.osaka-u.ac.jp.
Insights
Congenital left main coronary atresia, a rare condition, was successfully treated with redo coronary artery bypass grafting 27 years after initial surgery. This demonstrates long-term effectiveness of grafts for coronary artery disease management.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Congenital left main coronary atresia is an exceptionally rare coronary anomaly.
- Long-term outcomes and optimal management for recurrent ischemia post-surgery are not well-established.
- This case highlights successful redo coronary artery bypass grafting (CABG) for unstable angina 27 years after initial CABG for congenital left main coronary atresia.
Observation:
- A 33-year-old woman presented with unstable angina.
- She previously underwent CABG at age 6 for congenital left main coronary atresia.
- Despite patent grafts, ischemia persisted due to graft flow disruption.
Findings:
- Redo CABG using the right internal thoracic artery to the first diagonal branch successfully revascularized the left anterior descending artery territory.
- The patient experienced complete symptom resolution and remained well for over 3 years post-procedure.
- Coronary revascularization with saphenous vein and left internal thoracic artery grafts proved effective for long-term distal coronary artery supply.
Implications:
- This case underscores the potential for long-term graft patency and effectiveness in managing congenital coronary anomalies.
- It emphasizes the necessity of vigilant long-term surveillance for potential late graft failure or new coronary artery occlusions.
- Redo CABG can be a viable option for managing recurrent ischemia in adults with complex congenital coronary anomalies.
Background:
Congenital left main coronary atresia is an extremely rare coronary anomaly. Long-term surgical outcomes and the optimal management strategies for recurrence of ischemia remain uncertain. Herein, we present a case involving successful redo coronary artery bypass grafting for unstable angina 27 years after the initial coronary artery bypass grafting for congenital left main coronary atresia.
Case Presentation:
A 33-year-old woman was referred to our department with unstable angina. At the age of 6, she had undergone coronary artery bypass grafting of the second diagonal branch using the left internal thoracic artery and the obtuse marginal branch using saphenous vein grafting for left main coronary atresia. Although a coronary angiogram showed a patent left internal thoracic artery graft to the second diagonal branch and a patent saphenous vein graft to the obtuse marginal branch, the left anterior descending artery was not being perfused by the grafts because of a disruption of blood flow to the left anterior descending artery from the left internal thoracic artery. Therefore, we performed a redo coronary artery bypass grafting using the in situ right internal thoracic artery to the first diagonal branch, which was to be connected to the left anterior descending artery, resulting in amelioration of the ischemia of the left anterior wall. The patient was discharged 10 days after the operation and has been in good health for over 3 years without recurrence of chest symptoms.
Conclusions:
Coronary revascularization using a saphenous vein and left internal thoracic artery grafts is effective in achieving an adequate blood supply to the distal coronary arteries, and this effect can last for decades. However, careful follow-up is necessary because recurrent myocardial ischemia due to the development of a coronary artery occlusion may occur in adulthood.
