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J Thorac Cardiovasc Surg 1999;117:352-357
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

SURGICAL ANGIOPLASTY OF THE MAIN CORONARY ARTERIES IN CHILDREN

From the Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants Malades,^a and the Service de Chirurgie Cardiaque, Hôpital Laennec,^b Paris, France.

Received for publication Feb 4, 1998. Revisions requested March 24, 1998.; revisions received Sept 22, 1998. Accepted for publication Sept 29, 1998. Address for reprints: Pascal R. Vouhé, MD, Service de Chirurgie Cardiaque, Hôpital Laennec, rue de Sèvres, 75015 Paris, France.

Objective: To determine the safety and efficacy of surgical angioplasty of the coronary arteries in children.
Methods: We performed 9 surgical reconstructions of the left main coronary artery and 1 of the right coronary artery ostium in 10 children (mean age 5.7 years; range 2 months–15 years). The basic diseases included the following: congenital atresia of the left coronary artery (n = 2) and atresia of the right coronary artery in a patient with an aortoventricular tunnel (n = 1); stenosis of the left main coronary artery (1) in a patient with Williams syndrome (n = 1), (2) in a patient with familial hypercholesterolemia (n = 1), (3) after the arterial switch operation for transposition of the great arteries (n = 3), (4) after reimplantation of an anomalous left main coronary artery from the pulmonary artery (n = 1), and (5) by compression after a réparation à l'étage ventriculaire procedure (n = 1). Myocardial viability was assessed by single photon emission computed tomography (thallium 201; 7/10). The coronary artery stem was enlarged with a saphenous (n = 5), a pericardial (n = 4), or a polytetrafluoroethylene patch (n = 1).
Results: There was 1 hospital death and 9 patients are alive (mean follow-up 46 ± 30 months; range 12 months to 10.5 years). Eight of 9 survivors had a selective coronary artery angiogram and had normal coronary artery ostia. Two patients had stenosis of the left anterior descending coronary artery, 1 of whom underwent successful internal thoracic artery grafting.
Conclusions: Surgical angioplasty of the coronary stems restores physiologic coronary perfusion and conserves bypass material. It can be performed safely in children and provides encouraging midterm results.

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