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Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery in an Adult: Tubular Reconstruction of the Left Main Coronary Artery Under Coronary Perfusion
Author(s) -
Murashita Toshifumi,
Kubota Takehiro,
Kanaoka Tsuyoshi,
Zakaria Mohammed,
Yasuda Keishu
Publication year - 1997
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.1997.tb00138.x
Subject(s) - medicine , cardiology , pulmonary artery , artery , left coronary artery , right coronary artery , ascending aorta , left pulmonary artery , pulmonary valve , coronary arteries , aorta , myocardial infarction , coronary angiography
A bstract A 38‐year‐old female with anomalous origin of the left coronary artery (LCA) from pulmonary artery was surgically corrected by tubular reconstruction of the left main coronary artery (LMCA) using the pulmonary artery wall, and this repair was performed under beating heart. Thus, the pulmonary artery was divided above the orifice level and just above the pulmonary valve, and the commissure between nonfacing and left side sinuses was dissected away from the pulmonary artery wall to obtain lateral flaps. The pulmonary artery defect was reconstructed with a roll using an autologous pericardial patch, while the detached commissure was suspended on the pericardial patch. The long tube constructed using pulmonary artery tissue was anastomosed to the anterior aspect of the ascending aorta. These procedures were performed under beating heart simply by clamping the LMCA, since the preoperative myocardial contrast echocardiography confirmed the adequate coronary collateral flow from the right circulation. The postoperative course was uneventful, and a coronary artery angiogram demonstrated a widely patent LMCA. Our experience suggests that, in adult cases, this procedure could be performed without myocardial ischemia simply by clamping the LMCA because of well‐developed coronary collateral arteries. The safety of this technique could be confirmed by myocardial contrast echocardiography.