J Thorac Cardiovasc Surg 2001;122:843
© 2001 The American Association for Thoracic Surgery
Reply
John G. Byrne, MD
Brigham & Women&'s Hospital Boston, MA 02115
Reply to the Editor:
Doty's case lends further credence to our view that coronary angiography should be strongly considered before aortic valve surgery, even in young patients, so that the precise anatomy is understood before the operation. Even if mobilization of the anomalous left circumflex coronary artery away from the aortic anulus is not needed, as was the situation in Doty&'s patient, who received a stentless valve, preoperative knowledge of the anatomic course of the artery was likely very helpful in planning that operation. Furthermore, such preoperative knowledge would have been even more critical had a stented bioprosthesis or a mechanical valve been chosen. As Doty points out, the traditional oblique aortotomy may have resulted in injury to the anomalous artery in his patient. I agree with Doty&'s remarks that the precise course of the artery should at least be known, if not treated (dissecting the artery away from the anulus), so as to avoid coronary artery injury during suture placement into the aortic anulus.
12/8/118044doi:10.1067/mtc.2001.118044
