title: Anomalies of left coronary artery origin affecting surgical repair of hypoplastic left heart syndrome and Shone complex.
abstract: There has traditionally been less concern regarding coronary anomalies with left-sided congenital heart lesions such as hypoplastic left heart syndrome (HLHS)or Shone complex than with other lesions. However, coronary anomalies in this setting can profoundly affect surgical intervention, particularly when surgical repair involves the ascending aorta. We describe four patients with congenital left-sided heart lesions in which left coronary artery (LCA) anomalies substantially affected intervention and outcome. In the first two cases, the coronary anomalies were not identified prospectively and resulted in surgical injury directly to the coronary or to its surrounding region. In the latter two cases, successful identification of the coronary anomaly preoperatively allowed for modification of surgical technique and/or intervention. We conclude that detailed coronary artery assessment should be part of the routine echocardiographic evaluation of congenital left-sided heart lesions that require surgery.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan 48109-0204, USA. tsaroli@umich.edu
authors.forename: Tania
authors.initials: T
authors.lastname: Saroli
authors.forename: Sarah
authors.initials: S
authors.lastname: Gelehrter
authors.forename: Carlen A
authors.initials: CA
authors.lastname: Gomez-Fifer
authors.forename: Mary E
authors.initials: ME
authors.lastname: van der Velde
authors.forename: Edward L
authors.initials: EL
authors.lastname: Bove
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Ensing
mesh_terms: D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging / Q000601:surgery*; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D007090:Image Interpretation, Computer-Assisted; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D018570:Risk Assessment; D012494:Sampling Studies; D015996:Survival Rate; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods