Ann Thorac Surg 2008;86:665. doi:10.1016/j.athoracsur.2007.10.038
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Long-Term Fate of a 4-mm PTFE Tube Graft Used in Takeuchi Repair for Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery
Komarakshi Balakrishnan, MDa,*,
Narasimha Reddy, MDc,
Ranjit Sahadevan, MDb
a Department of Cardiothoracic Surgery, Ramachandra Medical College, Porur, Chennai, India
b Department of Pediatric Cardiology, Ramachandra Medical College, Porur, Chennai, India
c Cardiologist Vijaya Heart Foundation, Chennai, India
* Address correspondence to Dr Balakrishnan, Department of Cardiothoracic Surgery, Ramachandra Medical College, Chennai, 600116, India (Email: krbalakrishnan{at}vsnl.com).
A 6-month-old baby with anomalous left coronary artery from the pulmonary artery and severe heart failure was seen in 1990. There was severe left ventricular (LV) dysfunction with an ejection fraction of approximately 20%, with moderate mitral regurgitation.
A modified Takeuchi repair was done [1]. A 4-mm aortopulmonary window was created and a 4-mm polytetrafluoroethylene (PTFE) graft was anastomosed to this orifice from within the pulmonary artery and the other end of the graft was sutured around the left coronary ostium. A full tube of PTFE was used, as we believed it was the quickest way to establish a two coronary circulation, in view of the severe LV dysfunction. The main pulmonary artery was reconstructed with a pericardial patch. This case was reported in the literature [2].
The child, now a 17-year-old girl, has normal left ventricular function with an ejection fraction of 60% and no regional wall motion defect and a competent mitral valve. A coronary angiogram showed a normal left coronary system with an excellent patency of the PTFE graft (Figs 1A and B). In fact, the aortic root injection (Fig 1A) clearly demonstrates the high takeoff of the left coronary from the pulmonary artery side of the aorta from the created aortopulmonary window. It is hard to distinguish the normal coronary from the graft.
There was a hemodynamically insignificant gradient across the pulmonary valve of 18 mm Hg. The right ventricular function was normal.
There are very few reports documenting the fate of PTFE grafts in the coronary circulation in infants. In fact, in the only report we could find, the PTFE graft was found to be patent at 9 months after an arterial switch procedure with technical difficulties in coronary transfer [3].
We believe this is one of the longest follow-ups reported after PTFE graft replacement for coronary reconstruction done in early infancy.
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References
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- Takeuchi S, Imamura H, Katsumoto K, et al. New surgical method for repair of anomalous left coronary artery from pulmonary artery J Thorac Cardiovasc Surg 1979;78:7-11.[Abstract]
- Reddy KN, Ranjit S, Jagannath BR, Seshadri M, Balakrishnan KR. Successful management of Bland Garland White syndrome in infancy Indian J Pediatr 1992;59:275-279.[Medline]
- Albert D, Castilla J, Amengual E, et al. Arterial switch: aortocoronary bypass with interposition of polytetrafluoroethylene (Gore-tex) vascular graft Rev Esp Cardiol 1998;51:1009-1010.[Medline]
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