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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2003 April;44(2):173-8
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
Tireli E., Korkut A. K., Basaran M.
Department of Cardiovascular Surgery Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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.