Related Experiment Videos
[Aortocoronary bypass in children. Apropos of 6 cases]
D Bonnet1, P Bonhoeffer, Y Aggoun
1Service de cardiologie pédiatrique, hôpital Necker-Enfants malades, Paris.
Insights
Internal mammary artery bypass grafts are a feasible revascularization strategy in pediatric patients with complex coronary anomalies and acquired coronary disease. Early postoperative graft patency was excellent in this small cohort of young children.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Congenital Heart Disease
Context:
- Advancements in diagnostic imaging for myocardial ischemia and coronary anomalies have increased pediatric coronary revascularization procedures.
- Acquired coronary disease, often related to cardiac surgeries, presents new indications for revascularization.
Purpose:
- To report the early experience and feasibility of internal mammary artery (IMA) bypass grafts in pediatric patients.
- To evaluate the outcomes of IMA grafts in children with diverse coronary pathologies.
Summary:
- Seven IMA bypass grafts were performed in 6 children (3 days to 11.5 years) for conditions including left main coronary stenosis post-arterial switch, intramural left coronary lesions, congenital right ostium atresia, and Kawasaki disease-related coronary aneurysms.
- No operative fatalities occurred, and all grafts were patent on early postoperative assessment.
- The study highlights the feasibility of IMA grafting in very young children.
Impact:
- Demonstrates the viability of IMA bypass grafting as an early-age surgical option for pediatric coronary disease.
- Establishes a foundation for future research into long-term graft patency and vascular growth in pediatric bypass surgery.
Abstract:
The improvement in diagnostic techniques for myocardial ischaemia and in imaging of coronary anomalies in children has increased the number of coronary revascularisation procedures. Moreover, the indications are more diverse with the emergence of acquired coronary disease which was unknown until recently, related to operations comprising manipulation of the coronary arteries. The authors report their experience of 7 internal mammary artery bypass grafts in 6 children aged 3 days to 11.5 years (average 2 years): 3 left main coronary stenosis after arterial switch for transposition of the great arteries, 1 peroperative lesion of an intramural left coronary in a case of simple transposition of the great arteries, 1 congenital atresia of the right ostium associated with Tetralogy of Fallot, and 1 right coronary occlusion with giant aneurysms of the left coronary in a case of Kawasaki's disease. There were no operative fatalities. All the coronary grafts were patent at early postoperative control. These results indicate clearly that the method is very feasible from a very early age. Long-term patency, the growth of the anastomosis and of the distal vessels are questions which await a reply in the future.