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J Thorac Cardiovasc Surg 1994;108:1147-1148
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Anomalous origin of the left coronary artery from the pulmonary artery

Department of Thoracic and Cardiovascular Surgery
St. Mary's Hospital
422 Tubukuhonmachi
Kurume 830, Japan

Reply to the Editor:

We appreciate the comments of Drs. Paone and Silverman. They questioned the advantage of our new operative technique for use in adults with anomalous origin of the left coronary artery from the pulmonary artery, and they suggested that it is preferable to operate on the hypothermic fibrillating heart rather than using antegrade cardioplegic infusion during intracardiac repair.

We ¹ reported a new operative technique for treating patients who have anomalous origin of the left coronary artery from the pulmonary artery. An advantage of our new operative technique is that repair without the use of any prosthetic material is possible for any anatomic variation of the left coronary artery. We agree that this is more advantageous in infants and small children. However, in our adult patients, the postoperative course was uneventful and postoperative exercise thallium 201 myocardial imaging showed improved myocardial perfusion in the anteroseptal area. ² We believe this new operative technique is a good choice for adult patients with anomalous origin of the left coronary artery from the pulmonary artery.

We used antegrade cold crystalloid cardioplegia for myocardial protection during the period of our report. However, we now use retrograde continuous warm blood cardioplegia. ³ Antegrade infusion may cause maldistribution of the cardioplegic solution. In our cases, a longer time was needed for cardiac arrest than for our usual patients with coronary disease. We believe retrograde delivery of cardioplegic solution is a better choice for myocardial protection in patients with this anomaly.

References

1. Tashiro T, Todo K, Haruta Y, et al. Anomalous origin of the left coronary artery from the pulmonary artery: new operative technique. J THORAC CARDIOVASC SURG 1993;106:718-22.[Abstract]
   
2. Katsuragi M, Yamamoto K, Tashior T, et al. Thallium-201 myocardial spect in Bland-White-Garland syndrome: two adult patients with inferoposterior perfusion defect. J Nucl Med 1993;34:2182-4.[Abstract/Free Full Text]
   
3. Salerno TA, Houck JP, Barrozo CAM, et al. Retrograde continuous warm blood cardioplegia: a new concept in myocardial protection. Ann Thorac Surg 1991;51:245-7.[Abstract]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tadashi Tashiro Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tashiro, T. Articles by Todo, K. Search for Related Content PubMed Articles by Tashiro, T. Articles by Todo, K.