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Ann Thorac Surg 2000;69:568-571
© 2000 The Society of Thoracic Surgeons
a Division of Cardiovascular Surgery, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
b Division of Cardiology, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
Address reprint requests to Dr Black, Department of Cardiac Surgery, The Lucile Packard Children’s Hospital, Stanford University School of Medicine, Stanford, CA 94305-5407
e-mail: michael.black{at}leland.stanford.edu
Background. The origin of the coronary arteries from a single aortic sinus remains a rare congenital anomaly, once regarded as having little clinical significance. Contemporary surgical practice, however, frequently demands precise coronary reimplantation. In this article we emphasize a prophylactic surgical technique found especially helpful in the repair of D-transposition of the great arteries (D-TGA)/single coronary artery.
Methods. We reviewed the institutional cardiac registry.
Results. Since 1985, 398 neonates with D-TGA were repaired with the arterial switch procedure. A mortality rate of 38% was encountered in "simple" D-TGA (n = 174)/single coronary (2.9% left facing sinus (IRLCx), 7.5% right facing sinus (IIRLCx)) and 41% in neonates with D-TGA (n = 224)/single coronary (3.6% IRLCx, 12% IIRLCx). During the past 3.5 years the surgical mortality rate of neonates (n = 6) treated with origin of the coronary arteries from a single aortic sinus has dropped to 0%.
Conclusions. The surgical repair of D-TGA/single coronary artery continues to trouble surgeons. The implantation of a well-mobilized coronary "button" into a previously anastomosed neoaorta remains a key prophylactic technique in the achievement of good technical results.
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