Anatomical reconstruction of proximal coronary artery stenosis in children
A Krokovay1, R Prêtre2, O Kretschmar3
1Division of Congenital Cardiovascular Surgery, Paediatric Heart Centre, Children's Research Centre, University Children's Hospital, University of Zurich, Zurich, Switzerland.
Insights
Surgical reconstruction of pediatric coronary artery stenosis using anatomical techniques offers excellent long-term outcomes. This method effectively restores coronary blood flow, preserving future treatment options.
Area of Science:
- Pediatric cardiovascular surgery
- Congenital heart disease
- Coronary artery anomalies
Background:
- Proximal coronary artery stenosis and atresia in children require effective surgical solutions.
- Traditional methods may have limitations in restoring physiological coronary blood flow.
- Evolving techniques focus on anatomical reconstruction for improved outcomes.
Purpose of the Study:
- To evaluate the medium- to long-term outcomes of anatomical reconstruction for ostial and short segment proximal coronary artery stenosis in children.
- To assess the efficacy of patch plasty and interposition vein grafts in these complex cases.
Main Methods:
- Retrospective analysis of nine children undergoing ten left main coronary artery reconstructions.
- Utilized autologous great saphenous vein patch, autologous pericardium, xenopericardium, or great saphenous vein interposition grafts.
- Performed complementary wedge resection of stenotic coronary ostia in chronic cases.
Main Results:
- 100% survival rate at a median follow-up of 12.6 years.
- All patients maintained normal left ventricular ejection fraction.
- Follow-up angiography showed unobstructed coronary arteries in most cases, with one instance of non-significant obstruction.
Conclusions:
- Anatomical reconstruction of the proximal left coronary artery using autologous saphenous vein is a viable option.
- This technique facilitates optimal restoration of physiological coronary blood flow.
- It preserves the possibility of future coronary bypass surgery.
Objectives:
Timing and method of surgical reconstruction for non-sclerotic proximal coronary artery stenosis, occurring de novo or post-coronary artery transfer, are evolving. We have pursued a technique of anatomical reconstruction of ostial and short segment proximal coronary artery stenosis and atresia in children, using patch plasty or interposition vein graft. Here, we discuss the medium- to long-term outcomes.
Methods:
Nine consecutive children undergoing 10 left main coronary artery reconstructions using autologous great saphenous vein patch (n = 4), autologous pericardium (n = 4), xenopericardium (n = 1) or great saphenous vein interposition graft (n = 1) were retrospectively analysed. Complementary wedge resection of the stenotic coronary ostium was performed in chronic cases.
Results:
The aetiology of coronary artery stenosis was post-arterial switch operation (n = 6), Takayasu's arteritis (n = 1), idiopathic left main coronary artery atresia (n = 1) and anomalous origin of the left coronary artery from the pulmonary artery (n = 1). The median age and weight at operation were 0.15 (range 0.01-13.1) years and 4.4 (range 3-13.1) kg, respectively. Survival was 100% at the medi follow-up of 12.6 (range 1-19.2) years. All patients showed normal left ventricular ejection fraction on transthoracic echocardiogram. In 1 patient, kinking of the proximal left circumflex artery resulted in non-significant obstruction. In all other cases, follow-up catheter angiography revealed unobstructed coronary arteries. Cardiac magnetic resonance tomography showed no significant perfusion deficit in any child.
Conclusions:
Anatomical reconstruction of the proximal left coronary artery using autologous saphenous vein may allow optimal restoration of physiological coronary blood flow, keeping the option of future coronary bypass operation open.
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