A novel surgical approach to left main coronary artery giant aneurysm thrombosis in a child with a history of Kawasaki disease Jay D. Pruetz, MD, Masato.

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A novel surgical approach to left main coronary artery giant aneurysm thrombosis in a child with a history of Kawasaki disease Jay D. Pruetz, MD, Masato Takahashi, MD, Brian L. Reemtsen, MD, Vaughn A. Starnes, MD The Journal of Thoracic and Cardiovascular Surgery Volume 137, Issue 4, Pages 1030-1032 (April 2009) DOI: 10.1016/j.jtcvs.2008.02.048 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Preoperative cardiac angiogram of a giant LMCA aneurysm with thrombus causing a filling defect of the proximal LAD and complete occlusion of the circumflex artery. B, Postoperative angiogram of the LMCA at 24 months showing widely patent repair that fills the LAD and septal perforating branches. The circumflex is fed entirely by collateral blood flow from the RCA (not seen on this injection). LAD, Left anterior descending; LMCA, left main coronary artery. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1030-1032DOI: (10.1016/j.jtcvs.2008.02.048) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Diagram for novel surgical repair of a giant LMCA aneurysm with occlusive thrombus. A, LMCA aneurysm was readily noticeable on the anterior surface of the heart just lateral to the main pulmonary artery. B, Main pulmonary artery was opened transversely over the aneurysmal portion of the LMCA, and the aneurysmal sac was dissected out. Unroofing and resection of giant LMCA aneurysm were performed with removal of thrombus. A continuous endothelial tract was identified from the left main ostium to the LAD. C, Ring of main pulmonary artery was excised and opened for use as patch material (∗). Reroofing of the endothelial tract from the LCA ostium to the LAD was performed using the autologous tissue and a running stitch. D, Completed repair of LMCA. The ligamentum arteriosum was divided to mobilize the main pulmonary artery segment for end-to-end repair. E, Repair is completed by end-to-end anastomosis of the transected main pulmonary artery. LAD, Left anterior descending; LCA, left coronary artery; LMCA, left main coronary artery; MPA, main pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1030-1032DOI: (10.1016/j.jtcvs.2008.02.048) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions