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Ann Thorac Surg 2007;83:356-357
© 2007 The Society of Thoracic Surgeons

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Correspondence

Coronary Reimplantation During Jatene Procedure

Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Millet Caddesi, Capa, Fatih/Istanbul, 34390 Turkey

(Email: emintireli{at}yahoo.com).

To the Editor:

We read with interest the report by Kan and colleagues [1] in which they described their technique of relieving the tortioned right coronary artery (RCA) by a clockwise rotation of the heart. After the initial experiences, today the Jatene procedure is easily and safely performed with low mortality rates. The most important predictor of the outcome of the Jatene procedure is related to the transfer of the coronaries and ensuing ischemic events. There are different coronary artery transfer techniques defined for the arterial switch operations (ASO) and the success depends on the surgeon’s familarity with the technique. Generally any technique is suitable for arteries of the usual pattern, but for the patients with Jacoub coronary classification other than type A [2], special care should be taken to prevent ischemia. We prefer to perform the coronary reimplantations after completion of the neoaortic anastomoses in our patients with transposition of the great arteries, regardless of the coronary artery anatomy [3]. This is an easier and practical method. An additional advantage of this technique is that filling of the neoaorta after neoaortic reconstruction enables the points of the exact implantation regions of the coronary buttons and thus minimizes the risk of torsion or ischemia.

Authors have indicated that they have been faced with right coronary insufficiency. We assume it to be due to the prior coronary implantation rather than the neoaortic reconstruction. Especially for the tortuous RCA anatomy in ASO, RCA should be implanted to an upper level than to the left coronary artery (LCA). Otherwise, in this frequent complication, to overcome the problem, surgeons will prefer to lift the RCA anastomosis gently with pledgeted sutures. As Kan and colleagues [1] solved the problem by a 30-degree clockwise rotation of the heart with pericardial hanging sutures, the clockwise rotation maneuver of the heart itself should solve the problem; however, we suppose that this rotation may also increase the tension of the LCA anastomosis. They should explain the effect of this maneuver on the LCA anatomy. Furthermore, the sternal closure was unable to be performed in the early postoperative period and delayed until the ninth day. Could this have been an influence of the LCA insufficiency and following ischemic events resulting from the rotation of the heart and leading to a prolonged cardiac swelling?

In conclusion, coronary reimplantation after the neoaortic reconstruction facilitates the ASO. Reconstruction of the neoaorta before coronary implantation provides eases marking of the appropriate locations of the coronary buttons. We advocate this to be an easier, practical, and advantageous technique.

	References

Top References

 

1. Kan CD, Roan JN, Wu JM, Yang YJ. Relief of compromised translocated right coronary artery blood flow by clockwise rotation of the heart in a Jatene procedure Ann Thorac Surg 2006;81:742-744.[Abstract/Free Full Text]
2. Ugurlucan M, Sayin OA, Surmen B, Tireli E. Coronary reimplantation after neoaortic reconstruction in arterial switch operation Ann Thorac Surg 2006;82:382.[Free Full Text]
3. Tireli E, Korkut AK, Basaran M. Implantation of the coronary arteries after reconstruction of the neoaorta by using pericardial or pulmonary hood techniques: a significant impact on the outcome of arterial switch operations J Cardiovasc Surg (Torino) 2003;44:173-178.[Medline]

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				C.-D. Kan and Y.-J. Yang Reply. Ann. Thorac. Surg., January 1, 2007; 83(1): 357 - 358. [Full Text] [PDF]

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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Emin Tireli Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ugurlucan, M. Articles by Tireli, E. Search for Related Content PubMed PubMed Citation Articles by Ugurlucan, M. Articles by Tireli, E. Related Collections Coronary disease Related Article