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Right arrow Congenital - acyanotic

Ann Thorac Surg 2006;82:e19-e21
© 2006 The Society of Thoracic Surgeons

How to do it

The "Hinge-Twist" Technique for Anomalous Origin of the Left Coronary Artery

Leo Lopez, MD*, Laura Mercer-Rosa, MD, Evan M. Zahn, MD, Nolan R. Altman, MD, Renato Dubois, MD, Redmond P. Burke, MD

The Congenital Heart Institute at Miami Children's Hospital, Miami, Florida

Accepted for publication May 4, 2006.

* Address correspondence to Dr Lopez, Miami Children's Hospital, 3200 SW 60th Ct, Suite 104, Miami, FL 33155. (Email: llmd{at}llmd.net).

A murmur was heard in an asymptomatic boy (age 4), and transthoracic echocardiography revealed anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (age 6). Confirmed by catheterization and computed tomographic angiography (age 10), the LMCA followed a short interarterial course between the aorta and main pulmonary artery before supplying the anterior descending and circumflex coronary arteries. An intramural segment was not clearly seen. Results of stress testing were normal. Because sudden death was a concern, the patient underwent surgery at age 11. The "hinge-twist" technique was utilized in the absence of an intramural component or ostial stenosis in an effort to avoid the long-term complications of coronary reimplantation, ostial patching, or bypass grafting.






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