Ann Thorac Surg 2003;75:1773-1774
© 2003 The Society of Thoracic Surgeons
Original article: cardiovascular
Invited commentary
Hiromi Kurosawa, MDa
a Department of Cardiovascular SurgeryThe Heart Institute of Japan, Tokyo Women’s Medical University, 8-1 Kawadacho Shinjuku Tokyo 162-8666, Japan
e-mail: kurosawa{at}hij.twmu.edu
Transposition of the great arteries occasionally has complex coronary anatomy such as two or three arteries originate directly from the same sinus resulting in absent or very short right or left main trunk. Other unusual anatomies are (1) the right and anterior descending arteries originate from the right facing sinus (Shaher type 2); (2) the right and anterior descending arteries originate from the left sinus while the circumflex artery arises from the right facing sinus (Shaher type 4); and (3) the right coronary artery originates from the left facing sinus while the circumflex and anterior descending arteries originate from the right facing sinus (Shaher type 9). All of these are highly related to an unusual spatial relationship of the great arteries, such as right oblique and side-by-side relationship that has a coronary artery behind the pulmonary artery or in front of the aorta. All those configurations could easily cause bending, kinking, torsion or overstretching of the coronary artery [1].
Generally speaking, as the authors mentioned, the spatial relationship between the coronary cuff and the stem of the coronary artery changes more frequently after translocation in an arterial switch operation than in a Ross operation. Particular configurations such as intramural coronary arteries, a coronary artery with short main stem, multiple coronary orifice in the same sinus, and a coronary artery running between both great arteries are other conditions that make coronary translocation difficult.
Yamagishi and associates describe a new technique of coronary translocation in the arterial switch operation for transposition of the great arteries. The "bay window" technique could provide another surgical option for translocation of the coronary arteries to avoid late obstruction and underdevelopment—particularly in the above-mentioned unusual coronary anatomies. However, the bulged bay window demonstrated by the postoperative aortogram seems too large (Fig 3C) and may develop into aneurysmal dilatation of the aortic root in the future. Therefore, this technique should be appropriately employed so to avoid excessive deformity of the aortic root.
 |
References
|
|---|
- Kurosawa H., Imai Y., Takanashi Y., Hoshino S., Sawatari K., Kawada M., Takao A. Infundibular septum and coronary anatomy in Jatene operation. J Thorac Cardiovac Surg 1986;91:572-583.[Abstract]
Top
References