Expanding indications for pediatric coronary artery bypass

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Presentation transcript:

Expanding indications for pediatric coronary artery bypass Constantine Mavroudis, MD, Carl L. Backer, MD, Alexander J. Muster, MD, Elfriede Pahl, MD, John H. Sanders, MD, Vincent R. Zales, MD, Melanie Gevitz, BA The Journal of Thoracic and Cardiovascular Surgery Volume 111, Issue 1, Pages 181-189 (January 1996) DOI: 10.1016/S0022-5223(96)70415-4 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 A, Preoperative aortogram in 6.4-year-old boy who had previously undergone transatrial repair of tetralogy of Fallot with anomalous LAD from right coronary artery. Unrecognized injury to posterior LAD arterial wall resulted in depicted LAD–right ventricular fistula (arrow). B, Postoperative arteriogram showing patent and unobstructed LITA–LAD bypass graft 3 days after operation. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 181-189DOI: (10.1016/S0022-5223(96)70415-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 A, Preoperative aortogram in 6.4-year-old boy who had previously undergone transatrial repair of tetralogy of Fallot with anomalous LAD from right coronary artery. Unrecognized injury to posterior LAD arterial wall resulted in depicted LAD–right ventricular fistula (arrow). B, Postoperative arteriogram showing patent and unobstructed LITA–LAD bypass graft 3 days after operation. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 181-189DOI: (10.1016/S0022-5223(96)70415-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 A, Preoperative aortogram in 4-month-old girl showing prompt antegrade filling of right coronary artery and retrograde filling of LAD and circumflex branch. Preoperative differential diagnosis was anomalous left main coronary artery arising from pulmonary artery versus congenital left main coronary artery stenosis (arrow). B, Postoperative aortogram showing antegrade filling of both right and left main coronary arteries after autologous piece of pericardium was used to patch orifice of congenitally stenosed left main coronary artery. Because child could not be weaned from cardiopulmonary bypass, LITA– LAD graft was done, which was followed by separation from cardiopulmonary bypass. C, Occlusion aortogram showing unobstructed LITA–LAD bypass graft. Patient later underwent successful mitral valvuloplasty because of persistent mitral regurgitation and showed marked clinical improvement. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 181-189DOI: (10.1016/S0022-5223(96)70415-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 A, Preoperative aortogram in 4-month-old girl showing prompt antegrade filling of right coronary artery and retrograde filling of LAD and circumflex branch. Preoperative differential diagnosis was anomalous left main coronary artery arising from pulmonary artery versus congenital left main coronary artery stenosis (arrow). B, Postoperative aortogram showing antegrade filling of both right and left main coronary arteries after autologous piece of pericardium was used to patch orifice of congenitally stenosed left main coronary artery. Because child could not be weaned from cardiopulmonary bypass, LITA– LAD graft was done, which was followed by separation from cardiopulmonary bypass. C, Occlusion aortogram showing unobstructed LITA–LAD bypass graft. Patient later underwent successful mitral valvuloplasty because of persistent mitral regurgitation and showed marked clinical improvement. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 181-189DOI: (10.1016/S0022-5223(96)70415-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 A, Preoperative aortogram in 4-month-old girl showing prompt antegrade filling of right coronary artery and retrograde filling of LAD and circumflex branch. Preoperative differential diagnosis was anomalous left main coronary artery arising from pulmonary artery versus congenital left main coronary artery stenosis (arrow). B, Postoperative aortogram showing antegrade filling of both right and left main coronary arteries after autologous piece of pericardium was used to patch orifice of congenitally stenosed left main coronary artery. Because child could not be weaned from cardiopulmonary bypass, LITA– LAD graft was done, which was followed by separation from cardiopulmonary bypass. C, Occlusion aortogram showing unobstructed LITA–LAD bypass graft. Patient later underwent successful mitral valvuloplasty because of persistent mitral regurgitation and showed marked clinical improvement. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 181-189DOI: (10.1016/S0022-5223(96)70415-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 A, Selective coronary arteriogram in 4.8-year-old girl who had orthotopic cardiac transplantation and arch reconstruction because of hypoplastic left heart syndrome at age 1 month. As noted, transplanted heart has single coronary artery with long left main coronary artery traversing between great arteries, which is condition known to be associated with sudden death.27 LCA, Left coronary artery; RCA, right coronary artery. B, Selective subclavian arteriogram (lateral) showing LITA–LAD bypass graft (arrow) with both antegrade and retrograde coronary filling resulting in opacification of all three coronary arteries. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 181-189DOI: (10.1016/S0022-5223(96)70415-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 A, Selective coronary arteriogram in 4.8-year-old girl who had orthotopic cardiac transplantation and arch reconstruction because of hypoplastic left heart syndrome at age 1 month. As noted, transplanted heart has single coronary artery with long left main coronary artery traversing between great arteries, which is condition known to be associated with sudden death.27 LCA, Left coronary artery; RCA, right coronary artery. B, Selective subclavian arteriogram (lateral) showing LITA–LAD bypass graft (arrow) with both antegrade and retrograde coronary filling resulting in opacification of all three coronary arteries. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 181-189DOI: (10.1016/S0022-5223(96)70415-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Relative vessel sizes. Regression analysis relating normalized arterial size to body surface area (BSA). R2 values for right coronary (Cor.) artery, left anterior (Ant.) descending, and left internal (Int.) thoracic artery were 0.674, 0.701, and 0.855, respectively. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 181-189DOI: (10.1016/S0022-5223(96)70415-4) Copyright © 1996 Mosby, Inc. Terms and Conditions