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J Thorac Cardiovasc Surg 2007;134:1176-1178
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr James Jaggers (Durham, NC). In this paper the authors have reviewed their experience with these relatively rare and potentially lethal coronary artery anomalies. It is very difficult to know the actual prevalence of this lesion, but it is clear that as cardiologists’ skill with echocardiography and increased suspicion of coronary artery lesions increases, we will be asked to render opinions regarding the indications and outcomes of surgical intervention. Studies like this add significantly to our understanding of the surgical options.

Our experience is similar to yours. We have previously reported on 9 patients and subsequently performed this operation on 12 other patients, with no morbidity or mortality. Our experiences suggest that repair can be accomplished in the vast majority of patients. The obvious question that remains unanswered is whether we are actually positively affecting the lifetime risk of these patients or are we creating new risk for the future.

Dr Gulati, you and your group have used relatively standard techniques of unroofing or modified unroofing or reimplantation in 14 patients. However, in 4 patients, in whom the LCA or the RCA arises from the contralateral sinus and travels between the PAs without taking an intramural course, you have proposed a separate operation that includes PA translocation. You postulate that this will effectively relieve compression of the coronary artery between the great vessels, presumably during exercise.

I have several questions for you.

You stated that all your patients had cardiac catheterization before surgery. Is this necessary, and what do you think is the optimal diagnostic tool to confirm this anatomy? The anatomy is very important, as you know, to determine whether it is an intramural course versus an extramural course.

Dr Gulati. All of our patients did receive cardiac catheterizations, because we thought that this was the best technique . . . [Full Text of this Article]

Related Article

Surgical management of coronary artery arising from the wrong coronary sinus, using standard and novel approaches

Rajeev Gulati, Vadiyala Mohan Reddy, Casey Culbertson, Gregory Helton, Sam Suleman, Olaf Reinhartz, Norman Silverman, and Frank L. Hanley
J. Thorac. Cardiovasc. Surg. 2007 134: 1171-1178. [Abstract] [Full Text] [PDF]