Coronary Re-implantation after Completion of Neo-aortic Reconstruction in Arterial Switch Operation : Accurate Intraoperative Assessment for the Optimal Re-implantation Site

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概要

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• The arterial switch operation (ASO) has evolved into the treatment of the choice for most forms of transposition of the great arteries (TGA). Despite advancement in the technical aspects of the procedure, certain anatomical variations of the coronary arteries are still considered as surgical risks. We have recently employed a novel technique for coronary artery reconstruction in ASO to achieve further improvement of coronary transfer in cases with complex coronary anatomy. The technical key of the procedure is that reconstruction of the coronary arteries is preceded by neo-aortic anastomosis. After neo-aortic reconstruction is accomplished, the neo-aorta is temporarily distended with removal of the cross-clamp. The distended neo-aorta informs us its postsurgical geometry, which facilitates accurate assessment for the optimal site of coronary button transfer. The technique was feasible in 13 of 15 children who were consecutively treated by our group between 2003 and 2008. All patients recovered uneventfully and no coronary perfusion issue has occurred during the follow-up period. However, the complex anatomy of the coronary arteries in two children was not amenable to this technique. One with double loops (1RL; 2Cx) accompanied by side-by-side relationship of the great arteries underwent the open trapdoor technique, while the other with intramural coronary artery underwent the Imai method, that is one of procedure in which the coronary arteries are left in situ. The coronary re-implantation after neo-aortic reconstruction is promising to minimize postsurgical coronary ischemia and suitable for most ASO cases. However, various modifications of coronary transfer are required in a few variations of the coronary anatomy and we have to pursue further technical refinement of coronary artery transfer in ASO.

• 2009-12-01

著者

• SUZUKI Takaaki

  Department of Pediatric Cardiac Surgery, Saitama International Medical Center Saitama Medical Univer

• HOTODA Kentaro

  Division of Cardiovascular Surgery, Tokyo Metropolitan Kiyose Children's Hospital

• IWAZAKI Mika

  Department of Pediatric Cardiac Surgery, Saitama International Medical Center Saitama Medical Univer

• MASUOKA Ayumu

  Department of Pediatric Cardiac Surgery, Saitama International Medical Center Saitama Medical Univer

• KATOGI Toshiyuki

  Department of Pediatric Cardiac Surgery, Saitama International Medical Center Saitama Medical Univer

• Suzuki Takaaki

  Department Of Dermatology Kobe University School Of Medicine

• Ishikawa Masamichi

  Department Of Pediatric Cardiac Surgery Saitama University International Medical Center

• Iwazaki Mika

  Department Of Pediatric Cardiac Surgery Saitama International Medical Center Saitama Medical Univers

• Katogi Toshiyuki

  Department Of Pediatric Cardiac Surgery Saitama International Medical Center Saitama Medical Univers

• Katogi Toshiyuki

  Department Of Cardiovascular Surgery Keio University

• Masuoka Ayumu

  Department Of Pediatric Cardiac Surgery Saitama University International Medical Center

• Masuoka Ayumu

  Department Of Pediatric Cardiac Surgery Saitama International Medical Center Saitama Medical Univers

• Hotoda Kentaro

  Division Of Cardiovascular Surgery Tokyo Metropolitan Kiyose Children's Hospital

• Hotoda Kentaro

  Division Of Cardiovascular Surgery Keio University

• Masuoka Ayumu

  Department Of Pediatric Cardiac Surgery Saitama International Medical Center Saitama Medical Univers

• Suzuki Takaaki

  埼玉医科大学国際医療センター 小児心臓外科

• Iwazaki Mika

  Department Of Pediatric Cardiac Surgery Saitama International Medical Center Saitama Medical Univers

• Suzuki Takaaki

  Department of Applied Physics, Tokyo University of Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8610, Japan

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