title: An alternative technique for transfer of anomalous left coronary artery from the pulmonary trunk in children and adults using autogenous aortic and pulmonary arterial flaps.
abstract: BACKGROUND
  Direct re-implantation of an anomalous left coronary artery into the aorta is the preferred surgical option for creating a dual coronary arterial system in patients in whom the anomalous artery originated from the pulmonary trunk. This technique, however, is applicable only when the anomalous artery arises from the right posterior pulmonary sinus. We report a new technique for re-implantation using combined autogenous aortic and pulmonary arterial flaps in situations when a direct connection was not possible.
  
  
  METHODS
  We have treated 4 patients, aged 3 months, 6 months, 18 months, and 27 years respectively, who presented with anomalous origin of the left coronary artery from the left posterior pulmonary sinus. We used our proposed technique for transfer because lack of coronary arterial length, diminished vessel elasticity, and extensive collaterals around the pulmonary sinuses prevented direct attachment.
  
  
  RESULTS
  There was no early or late death. Postoperatively, all patients are in functional class I, with good biventricular function at a median follow-up of 74 months, with a range from 9 to 96 months. Postoperative coronary angiography in our 4th patient showed good arterial flow, without any distortion.
  
  
  CONCLUSIONS
  The potential benefits of this modification of the trapdoor technique are excellent operative exposure, use of autogenous and viable tissue capable of further growth, avoidance of injury to the aortic and pulmonary valvar apparatus and production of obstruction within the right ventricular outflow tract, complete elimination of use of pericardium for augmentation of the neo-aortic tube, achievement of the anastomosis with correct angling and length, and the possibility of implantation in all patients, including adults, regardless of the distance from the aorta or the coronary arterial configuration.
authors.affiliation: Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India. ujjwalchow@rediffmail.com
authors.forename: Ujjwal K
authors.initials: UK
authors.lastname: Chowdhury
authors.forename: Shyam S
authors.initials: SS
authors.lastname: Kothari
authors.forename: Chetan D
authors.initials: CD
authors.lastname: Patel
authors.forename: Anand K
authors.initials: AK
authors.lastname: Mishra
authors.forename: Priya
authors.initials: P
authors.lastname: Jagia
authors.forename: Ganapathy K
authors.initials: GK
authors.lastname: Subramaniam
authors.forename: Kizakke K
authors.initials: KK
authors.lastname: Pradeep
authors.forename: Raghu M
authors.initials: RM
authors.lastname: Govindappa
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000601:surgery*; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D006801:Humans; D007223:Infant; D018579:Patient Selection; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome