Ann Thorac Surg 2005;79:390
© 2005 The Society of Thoracic Surgeons
Correspondence
Reply
James Jaggers, MD
Duke University Medical Center, Box 3474, Durham, NC 27710, USA
jagge003{at}nc.duke.edu
To the Editor:
I thank Drs Furukawa and Itoh for their interest in our report [1] on surgical repair of anomalous origin of the coronary artery and for sharing their experience with this anomaly. I agree with them that excision and reimplantation of the anomalous coronary artery can be safely accomplished for some of these defects, but it can be difficult to excise the coronary artery button if there is a common orifice with the normally positioned coronary artery. The technique of reimplantation also requires substantially more dissection around the base of the aorta and may invite unintentional injury to the malpositioned coronary artery and possible kinking of that artery. Nevertheless, this is a viable technique.
It has been our practice to perform a simple unroofing of the intramural segment if this segment lies distal to the level of the commissure and to create a neo-orifice if the intramural artery courses at or below the level of the commissure. With this approach, we have seen no postoperative aortic insufficiency, normal coronary blood flow, and no mortality or morbidity. However, Drs Furokawa and Itoh are correct that only time will tell whether this technique predisposes the patient to aortic insufficiency. An important point is that there are few if any indications for coronary artery bypass grafting in patients with anomalous aortic origin of the coronary arteries.
References
- Romp RL, Herlong JR, Landolfo CK, et al. Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery. Ann Thorac Surg. 2003;76:589–596[Abstract/Free Full Text]
