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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 103-108, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
R Bunton, RA Jonas, P Lang, AJ Rein and AR Castaneda
Between 1959 and 1985, 24 patients (mean age 38 months, range 15 days to 13
years) with anomalous origin of the left coronary artery from the pulmonary
artery as an isolated lesion were treated surgically at Children's
Hospital, Boston. In 11 cases a left coronary-to-aortic tunnel was created
with a pulmonary artery baffle (Takeuchi) with no deaths either early or
late over a mean follow-up period of 18 1/2 months. Late complications of
this procedure include moderate aortic regurgitation (one), supravalvular
pulmonary stenosis (two-one required a second operation), obstructed baffle
(one-asymptomatic). In 11 cases of coronary ligation or ostial closure
there was a 27% early mortality and a 25% late mortality over a mean
follow-up period of 10 1/2 years. Late complications include residual shunt
(three-two required a second operation), severe mitral regurgitation (one),
and recurrence of angina (one). Two patients had other procedures. Both
early and late deaths occurred in the group who had congestive heart
failure and who had simple ligation. Five infants who had profoundly
depressed ventricular function and moderate to severe mitral regurgitation,
together with widespread Q waves on electrocardiogram, showed a dramatic
improvement in ventricular function after the Takeuchi procedure. The
Takeuchi procedure is a simple and effective means of establishing a two
coronary artery system in the child with anomalous origin of the left
coronary artery from the pulmonary artery. This procedure is particularly
recommended over coronary ligation in patients in congestive heart failure.
ARTICLES
Anomalous origin of left coronary artery from pulmonary artery. Ligation versus establishment of a two coronary artery system
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