Document Detail


Implantation of the coronary arteries after reconstruction of the neoaorta by using pericardial or pulmonary hood techniques. A significant impact on the outcome of arterial switch operations.
MedLine Citation:
PMID:  12813379     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: Coronary artery anomaly and techniques used for their transfer are the major risk factors for the arterial switch operation. Although various methods have been described, torsion and stretching of the coronary arteries continue to trouble surgeons. Especially, in cases in which there is a size mismatch between the aorta and the pulmonary artery, the true coronary implantation points can change. METHODS: We studied the incidence of myocardial ischemia in 40 patients who underwent a Jatene procedure from January 1997 to August 2000 at Istanbul Medical Faculty of Istanbul University. In all cases; firstly, the neo-aortic anastomosis was performed. After filling the neo-aorta by removing the aortic cross-clamp, we aimed to identify the exact coronary implantation points. In 26 cases, direct re-implantation or trap-door techniques were the method of choice used for the implantation. In 14 cases, we used pericardial or pulmonary hood augmentation techniques. In 12 of these 14 cases, we used directly pericardial or pulmonary hood for the maintenance of the exact coronary geometry because of the unfavorable anatomy. In the remaining 2 patients, because of the determination of ischemic changes on the electrocardiogram during the rewarming phase, we should revise the coronary anastomosis by a pericardial hood. RESULTS: One patient with intramural course of the coronary arteries died from of myocardial ischemia. In the remaining 39 patients, we did not see postoperative morbidity and mortality because of the myocardial ischemia. CONCLUSION: The use of pericardial or pulmonary hood augmentation techniques is very helpful for the maintenance of the exact coronary geometry. Reconstruction of the neoaorta prior to coronary anastomosis allows a more accurate determination of the true coronary implantation points; especially, if there is an abnormal relationship and size mismatch between the great vessels. By this innovative technique, the more accurate geometry and angulation of the coronary arteries can be achieved.
Authors:
E Tireli; A K Korkut; M Basaran
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of cardiovascular surgery     Volume:  44     ISSN:  0021-9509     ISO Abbreviation:  J Cardiovasc Surg (Torino)     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-06-18     Completed Date:  2003-08-18     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0066127     Medline TA:  J Cardiovasc Surg (Torino)     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  173-8     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. emintireli@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical
Aorta / surgery
Blood Vessel Prosthesis Implantation*
Cardiac Surgical Procedures*
Coronary Vessel Anomalies / surgery*
Humans
Myocardial Ischemia / etiology,  prevention & control
Pericardium / surgery
Pulmonary Artery / surgery
Reconstructive Surgical Procedures
Replantation
Transposition of Great Vessels / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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