title: [Four cases of the anomalous origin of the left coronary artery from the pulmonary artery].
abstract: We report perioperative management of 4 patients with anomalous origin of the left coronary artery from the pulmonary artery. This report involves with 3 infant cases and an adult. Two infants underwent coronary reimplantation procedure and Takeuchi's method was performed on the other infant. In all infant cases, mitral valve plasty was performed to correct mitral regurgitation secondary to papillary muscle dysfunction. The adult patient underwent CABG with ligation of LCA. General anesthesia was performed with high doses of fentanyl in all cases. We employed a relatively high PaCO2 and low FIO2 in order to maintain a high pulmonary vascular resistance. It aims to decrease the incidence of left to right shunt. We used epinephrine to wean one infant and the adult from cardiopulmonary bypass. Perioperative course was uneventful with the use of catecholamines and high doses of vasodilators for left ventricular dysfunction and coronary perfusion under mechanical ventilation.
authors.affiliation: Department of Anesthesiology and Resuscitology, Okayama University Medical School, Okayama 700-8558.
authors.forename: Y
authors.initials: Y
authors.lastname: Toda
authors.forename: M
authors.initials: M
authors.lastname: Takeuchi
authors.forename: K
authors.initials: K
authors.lastname: Morita
authors.forename: K
authors.initials: K
authors.lastname: Oe
authors.forename: T
authors.initials: T
authors.lastname: Iwasaki
authors.forename: N
authors.initials: N
authors.lastname: Taga
authors.forename: M
authors.initials: M
authors.lastname: Kosaka
authors.forename: M
authors.initials: M
authors.lastname: Hirakawa
mesh_terms: D000768:Anesthesia, General; D002395:Catecholamines / Q000008:administration & dosage; D001026:Coronary Artery Bypass; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D004837:Epinephrine / Q000008:administration & dosage; D005112:Extracorporeal Circulation; D005260:Female; D005283:Fentanyl; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage; D019990:Perioperative Care; D011175:Positive-Pressure Respiration; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000601:surgery*; D012086:Reoperation
chemical_list: D002395:Catecholamines; D005996:Nitroglycerin; D005283:Fentanyl; D004837:Epinephrine