[The repair of congenital coronary artery fistula in the neonatal period].
We operated on 10 cases diagnosed as congenital coronary artery fistula, including 2 critical neonates. Such neonates needed special care for perfusion pressure drop at the beginning of cardiopulmonary bypass and imperfect delivery of cardioplegia. This phenomenon is likely to depend on the shunt size of a fistula, that is much larger in such neonates than in older patients who could be operated on electively. It was helpful in the situation to crossclamp the main PA, compress the fistula and crossclamp the aorta quickly for a standstill. We prefer the closure of a fistula in the recipient chamber especially when an important area is supplied distally to the origin of the fistula. However, if a ventricle is a recipient chamber, the closure through coronary incision should be done as the neonates in our series. There were two hospital deaths due to vascular leakage syndrome and hypoxia, respectively. Aortic regurgitation (AR) got worse in two after the operation. They were found to have more dilatation and distortion in the Valsalva's sinus which appeared to affect the aortic annulus to some extent. It is likely due to long-standing larger shunt. Contrary to them, the patient operated on during neonatal period was followed by no increase of AR, though she had the largest shunt of our series. We have an impression it could be prevented by earlier operation.
Nagato
H
H
Department of Cardiovascular Surgery, Shizuoka Children's Hospital, Japan.
Yokota
M
M
Sakamoto
K
K
Kado
M
M
Nishioka
M
M
Fujimoto
K
K
Ikai
A
A
D001022:Aortic Valve Insufficiency / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D005402:Fistula / Q000601:surgery*; D006324:Heart Arrest, Induced; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011183:Postoperative Complications / Q000517:prevention & control; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures