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Ann Thorac Surg 2006;82:383
© 2006 The Society of Thoracic Surgeons

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Correspondence

Reply

Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-061, Korea (South)

(Email: scsung21{at}hanmail.net).

To the Editor:

We read the letter by Dr Ugurlucan and colleagues [1] in response to our article [2]. We appreciate their kind comments. They gave us an idea of "leaving a 3–4 mm open region at the neoaortic anastomosis for possible placement of the coronary button." We think that the idea is good and practical for the coronary artery patterns with posterior looping. However we think that breakdown of the neoaortic suture line during coronary implantation is not a big problem because it could be easily repaired. Moreover we do not have any experience of breaking down of the neoaortic suture line when implanting coronary buttons after neoaortic reconstruction. When we anticipate somewhat higher implantation of the coronary button, we transect the main pulmonary artery slightly higher at its anterior wall and slightly lower at its posterior wall. Anterior protrusion of the neoaorta can be prevented by somewhat distal transection of the ascending aorta. With this maneuver, we could implant coronary buttons below the neoaortic suture line in all but one patient. We implanted two coronary buttons above the neoaortic suture line in a patient with high take-off coronary arteries. In this patient, we intentionally transected the main pulmonary artery at the low level and implanted the coronary buttons above the neoaortic suture line without disrupting it. We think that appropriate angle and tilt of the coronary buttons, as well as the height of the implantation site, are very important when we transfer the right coronary artery with posterior looping left coronary artery or left circumflex artery to the neoaorta.

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1. Ugurlucan M, Ali Sayin O, Surmen B, Tireli E. Coronary reimplantation after neoaortic reconstruction in arterial switch operation (letter) Ann Thorac Surg 2006;82:382.[Free Full Text]
2. Chang YH, Sung SC, Lee HD, Kim S, Woo JS, Lee YS. Coronary reimplantation after neoaortic reconstruction can yield better result in arterial switch operationcomparison with open trap door technique. Ann Thorac Surg 2005;80:1634-1640.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yun Hee Chang Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chang, Y. H. Articles by Sung, S. C. Search for Related Content PubMed Articles by Chang, Y. H. Articles by Sung, S. C. Related Collections Congenital - cyanotic Related Article