title: 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.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. emintireli@yahoo.com
authors.forename: E
authors.initials: E
authors.lastname: Tireli
authors.forename: A K
authors.initials: AK
authors.lastname: Korkut
authors.forename: M
authors.initials: M
authors.lastname: Basaran
mesh_terms: D000714:Anastomosis, Surgical; D001011:Aorta / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D006801:Humans; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control; D010496:Pericardium / Q000601:surgery; D011651:Pulmonary Artery / Q000601:surgery; D019651:Plastic Surgery Procedures; D012092:Replantation; D014188:Transposition of Great Vessels / Q000601:surgery*