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Internal mammary artery to coronary artery bypass in paediatric cardiac surgery
E Brackenbury1, H Gardiner, K Chan
1Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK.
Insights
Internal mammary artery grafts are effective for pediatric coronary artery bypass surgery in complex cases. These grafts showed good growth and patency in young patients with congenital heart defects.
Area of Science:
- Pediatric cardiac surgery
- Vascular grafting techniques
- Congenital heart disease
Background:
- The internal mammary artery is the preferred conduit for coronary artery bypass grafting in adults.
- Its use in pediatric surgery is limited, primarily documented in patients with Kawasaki's disease.
Observation:
- This study reports on five pediatric patients requiring internal mammary artery-coronary artery grafting.
- Grafting was necessitated by complex coronary artery anatomy.
- Two cases involved transposition of the great arteries, and three involved anomalous left coronary artery from the pulmonary artery.
Findings:
- Late-stage angiography confirmed satisfactory growth of the internal mammary artery grafts.
- The conduits demonstrated excellent patency in all five pediatric patients.
Implications:
- Internal mammary artery grafting is a viable and effective option for complex pediatric coronary artery reconstruction.
- This technique supports long-term graft patency and growth in young patients.
- Further research into the long-term outcomes of this approach in pediatric populations is warranted.
Abstract:
The internal mammary artery is regarded as the optimal conduit for coronary artery bypass grafting in adults. Use of this conduit in paediatric surgery is rare and has been reported mainly in patients with Kawasaki's disease. We report five patients who required internal mammary-coronary artery grafting due to adverse anatomical disposition of the coronary artery. In two cases an internal mammary graft was required during correction of transposition of the great arteries. The other cases involved correction of a left coronary artery arising anomalously from the pulmonary artery. Late angiography shows satisfactory growth and patency of the conduits.