Transfer technique of an anomalous coronary artery from the anterior pulmonary artery

We describe a simple rerouting technique for an anteriorly situated anomalous left coronary artery from the pulmonary artery (ALCAPA), extending the left main coronary trunk with autologous aortic and pulmonary tissue. This technique is reproducible. It provides a tension-free aortocoronary anastomosis and a full potential for future growth.     

Left superior pulmonary artery sling

A pulmonary artery sling is formed when the left pulmonary artery originates from the right pulmonary artery and encircles the distal trachea, coursing between the trachea and esophagus to reach the hilum of the left lung. Pulmonary artery slings are often associated with distal tracheal narrowing, due to either intrinsic stenosis or secondary compression by the anomaly itself. We report a very rare case in which the left superior pulmonary artery originated from the right pulmonary artery and then acted as a sling, the left inferior pulmonary artery originated from the pulmonary trunk.     

Aortic origin of the right pulmonary artery: a cause of heart failure in infancy at high altitude

The development of technique for surgical correction of aortic origin of the right pulmonary artery is described. In the first patient, aged 7 years, the operation was performed via bilateral thoracotomy, with standby for extracorporeal circulation, and the right pulmonary artery was anastomosed directly to the left, using side clamps on both aorta and left pulmonary artery. The currently preferred procedure is to operate as early as possible in infancy, using perfusion at 30 degrees C with ventricular fibrillation and without cross-clamping of the aorta. Wide mobilization of the pulmonary artery probably prevents stenosis at the end-to-side anastomosis.     

Left pulmonary artery coarctoplasty by using the right pulmonary artery flap near the arterial duct

Coarctation of the left pulmonary artery may coexist with tetralogy of Fallot or pulmonary atresia with ventricular septal defect. Various surgical methods, such as autologous pericardial patching and intraoperative pulmonary artery stenting, have been used for solving this condition. We proposed a simple and effective technique for treating patients with left pulmonary artery coarctation and pulmonary atresia with ventricular septal defect by using the right pulmonary artery flap for left pulmonary artery coarctoplasty, plus central shunt creation by V-Y plasty.     

David's procedure for pulmonary artery aneurysm

Pulmonary artery aneurysm (PAA) is a rare entity with fatal complications. Its silent course contributes to large aneurysms with compression symptoms. We present a 39-year-old female idiopathic pulmonary arterial hypertension patient with a giant PAA causing severe pulmonary regurgitation (PR) and symptomatic left main coronary artery compression (LMCA). Since she had a failed LMCA stenting attempt, she underwent surgery. A valve-sparing David-like pulmonary trunk reconstruction and coronary artery bypass were performed. This case illustrates that David-like reconstruction procedure can be applied to the PAA with severe PR.     

Anomalous origin of the left coronary artery from the right pulmonary artery.

A previously unknown coronary artery anomaly is reported: origin of the left coronary artery from the right pulmonary artery. This unusual anomaly can probably be explained by the theory of dual embryonic development of the coronary arteries from angioblastic buds in the truncus arteriosus. It is thought that these buds anastomose with a capillary network that is developing on the surface of the ventricles. Complete repair of this lesion with restoration of a two-coronary artery system was accomplished in a 10-month-old baby. The coronary artery was detached from the pulmonary artery, with a button of pulmonary artery being retained around the coronary artery ostium. Direct systemic arterial flow to the left coronary artery was established by anastomosis of the left coronary to the right subclavian artery.     

Balloon angioplasty for pulmonary artery stenosis after lung transplantation

We report here a successful case of balloon angioplasty for a stenosis of the pulmonary artery after lung transplantation. A 49-year-old patient with end stage diffuse bronchiectasis with sinusitis underwent bilateral living donor lobar lung transplantation. After treatment of postoperative right pneumothorax, a perfusion lung scan revealed deficient perfusion in the left lung. Pulmonary angiography showed a severe stenosis in the left pulmonary artery just distal to the anastomosis. Percutaneous balloon angioplasty improved both pulmonary perfusion and respiratory function.     

A new experimental model of pulmonary hypertension in dog using an adjustable pulmonary artery band

In order to study pathogenesis, reversibility, and treatment of pulmonary hypertension in congenital heart disease, a new experimental model to induce pulmonary vascular diseases has been designed. Previous models by other investigators were anastomosis between a systemic artery and pulmonary artery of one lung lobe, and these could not provide constant induction of pulmonary vascular diseases. Furthermore the postoperative mortalities in their experiences were quite high and acute iatrogenic pathological changes such as bleeding, edema and emphysema developed in the pulmonary vasculature and parenchyma of the anastomosed lobe. Use of our adjustable pulmonary artery band has eliminated such unwanted complications. The surgical procedure includes an end-to-side anastomosis of the left main pulmonary artery to the descending thoracic aorta, and banding of the anastomosed pulmonary artery using the adjustable band. The band was gradually loosened by extrathoracic manipulation during three to four weeks observation after operation. This technique provided dogs to survive sufficiently long enough and with a high success rate, and to produce extremely advanced pulmonary vascular diseases. Of the twenty dogs operated such, eighteen survived the first postsurgical week and thirteen dogs developed hypertensive pulmonary vascular diseases. Development of the medial hypertrophy was evident at one week and gradually advanced. In eight weeks, intimal cellular proliferation (Grade 2 of the Heath & Edwards' classification) became apparent. In twelve weeks, the intimal proliferation became fibrous and acellular (Grade 3) and caused complete obstruction of the lumen of some muscular arteries. In twenty weeks specimen, typical plexiform lesions (Grade 4) and dilatation lesions (Grade 5) involved the small muscular arteries in the whole left lung.(ABSTRACT TRUNCATED AT 250 WORDS)     

Left coronary artery from the pulmonary artery: Physiological considerations of surgical correction

A 13-year-old boy with anomalous origin of the left coronary artery from the pulmonary artery has been studied before and after anastomosis of the artery to the aorta, using a saphenous vein graft. There was suggestive evidence of improved left ventricular function following operation. The presence of associated mitral regurgitation is suspected from the auscultatory findings.     

肺动脉高压幼犬肺动脉压力与肺动脉结构的关系

目的 探讨肺动脉高压（ＰＨ）时肺动脉压力（ＰＡＰ）与结构的关系。方法 实验幼犬１５条,分２组：分流组（ｎ＝１２）,正常对照组（ｎ＝３）。分流术后９０ｄ两组行血流动力学检测后,放血处死,肺组织切片行病理学检测。结果 （１）分流组左下肺动脉压（ＰＬＬＰＡ）由１．３６ｋＰａ（１ｋＰａ＝０．７５ｍｍＨｇ）升至１１．１３ｋＰａ,左下肺血管阻力（ＬＬＰＶＲ）由５．６５Ｗｏｏｄ’ｓ单位升至１４．３１Ｗｏｏｄ’ｓ     

Temporary one-and-a-half ventricular repair to relieve lymphomatous obstruction of the pulmonary artery

Mediastinal lymphoma may infiltrate the conoarterial junction of the heart and cause life-threatening compression of the pulmonary artery. Partial debulking of the tumor along the left pulmonary artery and creation of a cavopulmonary anastomosis on the right pulmonary artery restored satisfactory perfusion of the lungs and unloading of the right ventricle in a 19-year-old woman. Remission of the tumor after chemotherapy allowed subsequent takedown of the cavopulmonary anastomosis.     

Anomalous origin of the left coronary artery from the pulmonary artery A case using the autologous pulmonary arterial wall graft.

A 10-year-old girl with anomalous origin of the left coronary artery from the pulmonary artery underwent a two coronary system reconstruction with a new technique. Her left coronary artery was stenotic next to its origin and had a severe adhesion with the aorta. We made a bypass grafting between the aorta and the left coronary artery with a roll shaped transected main pulmonary arterial wall graft. The postoperative angiogram showed a good patency of a reconstructed left coronary artery. This technique is considered useful surgical option for bypass grafting to the left coronary artery when the left coronary artery has an obstructive lesion or a difficulty to dissect and mobilize.     

Subclavian--coronary artery anastomosis in infancy for the Bland-White-Garland syndrome: a two-year angiographic follow-up

A 6-month-old female infant with anomalous origin of the left coronary artery underwent an end-to-end anastomosis of the left subclavian artery to the left coronary artery. A cuff of the pulmonary artery was used for the anastomosis. The child continued to have mitral regurgitation but has done well with medical treatment over the last four years. Cardiac catheterization 26 months after operation confirmed a patent graft without narrowing, improved contractility of the left ventricle, normal end-diastolic pressure of the left ventricle, and persistent mitral regurgitation. This technique is applicable in infants regardless of the size of the left coronary artery.     

"Spiral-cuff" technique for repair of anomalous left coronary artery from the pulmonary artery

We describe a new technique for coronary transfer in the repair of anomalous origin of the left coronary artery from the pulmonary artery. The left coronary artery is elongated with the native pulmonary artery wall to form a spiral-shaped coronary cuff to construct an unstretched new left coronary artery system from the ascending aorta. A postoperative angiographic scan showed good flow of the left coronary artery without any kinking or narrowing. This technique is considered useful when an anomalous coronary artery arises a long way from the ascending aorta.     

Primary repair of pulmonary artery sling with double outlet right ventricle and distal tracheal stenosis

The fate of patients with pulmonary artery sling depends on associated tracheal lesions. Distal tracheal stenosis involving the carina frequently results in lethal obstruction due to secretion or inflammatory edema. Further-more, associated complex cardiac anomalies with excessive pulmonary flow make the situation more complicated. We present a case of successful simultaneous one-stage repair of pulmonary artery sling, double outlet right ventricle and distal tracheal obstruction. Pulmonary artery sling was relieved by relocation of the left pulmonary artery (left pulmonary artery to main pulmonary artery) and a tracheoplasty (resection and end-to-end anastomosis). We advocate early aggressive simultaneous repair of pulmonary artery sling with tracheal stenosis and concomitant repair of intracardiac anomalies whenever possible.     

Left pulmonary artery occlusion due to compression by aortic aneurysm

A 72-year-old man with shock was transferred to our emergency room. The computed tomograms revealed a ruptured giant thoracic aortic aneurysm obstructing the left pulmonary artery. Emergency total aortic arch replacement was performed, and the postoperative course was uneventful. The postoperative angiography confirmed the total occlusion in the left pulmonary artery which was due to compression by the aortic aneurysm.     

Pulmonary arteriopexy to prevent pulmonary artery kinking in orthotopic heart transplantation

Heart transplantation is still the best treatment for patients with end‐stage heart failure unresponsive to medical therapy or those treated with mechanical circulatory support. The surgical technique for heart transplantation is fraught with potential complications. One of these potential complications, kinking of the pulmonary artery after anastomosis of the recipient and donor pulmonary arteries, has been reported as a cause of acute right ventricular failure. We describe a technique to ensure proper configuration of the pulmonary artery after heart transplantation via a pulmonary arteriopexy to restore a physiologically appropriate angle of the great vessels.     

Translocation of dilated pulmonary artery for relief of bronchial compression associated with ventricular septal defect

Bronchial compression due to a dilated pulmonary artery is a troublesome problem in the surgical management of infants or children with congenital heart disease. We experienced an infantile case of ventricular septal defect and prolonged respiratory insufficiency caused by right bronchial compression and left pulmonary hypoplasia. Anterior translocation of the dilated right pulmonary artery and intracardiac repair succeeded in relieving the bronchial compression and improving left pulmonary function. We advocate that this procedure is useful for bronchial compression with congenital heart disease and maldevelopment of the lung.     

An adult case of anomalous origin of the left coronary artery from the pulmonary artery with the coronary artery-bronchial artery anastomosis]

A case was 33 years old man who had complained chest pain during exercise. He was diagnosed anomalous origin of the left coronary artery from the pulmonary artery by coronary angiography. At operation, left main coronary artery originated from the posterior wall of the pulmonary artery. Numerous retrograde flow was seen through left coronary artery during aortic cross clamping. The left coronary ostium was closed, because sufficient extracardial anastomosis to coronary artery should be thought. The post operative course was uneventful and the patient is asymptomatic. The selective bronchial artery angiography was performed and it demonstrated collaterals between the bronchial artery and the left circumflex artery. The Thallium scintigraphy had showed ischemia of antrolateral wall of the left ventricle before operation, but postoperatively there was no ischemic redistribution.     

New technique in the transfer of an anomalously originated left coronary artery to the aorta.

A 21-month-old girl with an anomalous origin of the left coronary artery underwent a transfer of the left coronary artery to the aorta using a new technique of coronary prolongation. Because the anomalous left coronary artery arising from the left anterior aspect of the pulmonary trunk was too short to reach the aorta, a simple transfer of the left coronary artery to the aorta was deemed impossible. Therefore, a transfer was performed with the help of a coronary prolongation technique using the cuff of the pulmonary trunk and an aortic flap. The new route of the left coronary artery was established anterior to the pulmonary trunk. Postoperative angiography showed a patent left coronary artery without any narrowing or kinking, as well as an improved contractility of the left ventricle. Postoperative cardiac scintigraphy showed a decreased ischemic area. This technique is thus considered applicable when the orifice of the anomalous left coronary artery is too distant from the aorta for a direct anastomosis.