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Ann Thorac Surg 2008;86:1722. doi:10.1016/j.athoracsur.2008.02.065
© 2008 The Society of Thoracic Surgeons
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Tayyar Sarioglu
Ece Salihoglu
Ersin Erek
Yusuf Kenan Yalcinbas
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Correspondence

Pericardial Tube for Translocation in Anomalous Origin of Coronary Arteries

Tayyar Sarioglu, MD, Ece Salihoglu, MD, Ersin Erek, MD, Yusuf Kenan Yalcinbas, MD

Cardiovascular Surgery Department, Acibadem Heart Center, Acibadem Bakirkoy Hospital, Halit Ziya Usakligil cad. No. 1, Istanbul, 34140 Turkey

(Email: salihogluece{at}yahoo.fr).

To the Editor:

We read with great interest the work by Wu and Xu [1] and we would like to add comments to the discussion.

Remote left coronary artery (LCA) has always been a serious problem in patients with anomalous origin of the LCA from pulmonary artery (ALCAPA). Many surgeons have devised various modifications to elongate a remote LCA [2]. The authors proposed using the pulmonary artery wall as a tube to elongate the LCA. A similar method with good outcomes for more than 5 years of follow-up has been published [3, 4].

We used a similar idea to solve different coronary problems in 4 patients by constructing a tube graft with autologous pericardium. The pathology was ALCAPA with remote LCA in 2 patients. The other patients had transposition of the great arteries (TGA) with an inverted coronary artery pattern; one of them also had an intramural course. All patients had uneventful recoveries. Two patients (1 with ALCAPA, another 1 with TGA) had coronary angiography 5 years after operation. The tube grafts were widely open, and the coronary circulation was intact (Fig 1). Total follow-up is now 5 to 11 years. No wall motion abnormality has been detected by echocardiography, and exercise stress tests are normal.


Figure 1
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  		Fig 1. Postoperative fifth year angiography in a patient with anomalous left coronary artery from the pulmonary artery.

 
We prefer using a pericardial tube to avoid removing tissue from the great arteries to establish a normal coronary circulation with optimal anatomy. We suggest that autologous pericardium can be used to construct the tube graft with good early-term and long-term patency. We believe that elongation of the coronary artery with a tube graft facilitates transfer to the aorta in various surgical procedures, and we recognize that all types of autologous material can be used with satisfactory results.


   References
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 References
 

  1. Wu Q, Xu Z. An alternative procedure for correction of anomalous origin of left coronary artery from the pulmonary artery Ann Thorac Surg 2007;84:2132-2133.[Abstract/Free Full Text]
  2. Tsang VT, Stark J. Congenital coronary artery fistula and anomalous origin of the left coronary artery from the pulmonary arteryIn: Stark JF, De Leval MR, Tsang VT, editors. Surgery for congenital heart defects. 3rd edit.. West Sussex: John Wiley & Sons; 2006. pp. 609-619.
  3. Turley K, Szarnicki RJ, Flachsbart KD, Richter RC, Popper RW, Tarnoff H. Aortic implantation is possible in all cases of anomalous origin of the left coronary artery from the pulmonary artery Ann Thorac Surg 1995;60:84-89.[Abstract/Free Full Text]
  4. Barth MJ, Allen BS, Gulecyuz M, Chiemmongkoltip P, Cuneo B, Ilbawi MN. Experience with an alternative technique for the management of anomalous left coronary artery from the pulmonary artery Ann Thorac Surg 2003;76:1429-1434.[Abstract/Free Full Text]

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Qingyu Wu
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Ann. Thorac. Surg., November 1, 2008; 86(5): 1722 - 1722.
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This Article
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Tayyar Sarioglu
Ece Salihoglu
Ersin Erek
Yusuf Kenan Yalcinbas
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