Left internal thoracic artery bypass graft in arterial switch with coronary transfer for transposition of the great arteries

Pediatric Coronary Artery Bypass Surgery for Congenital Heart Disease

BACKGROUND

Pediatric coronary artery bypass surgery (PCABS) for congenital heart disease has become increasingly important in infants and children undergoing modern cardiac surgical procedures, because of its life-saving potential in unsuccessful coronary transfer operation. This review summarizes the current surgical role of PCABS for treating congenital heart diseases.

METHODS

Databases, mainly PubMed, were searched for relevant publications about coronary bypass operation in the pediatric population, from 1970 (commencement) to March 2018.

RESULTS

The five main indications were (1) anomalous origin of the left coronary artery from the pulmonary artery, (2) left main coronary trunk atresia, (3) acute and late coronary events in the arterial switch operation for transposition of the great arteries, (4) the Ross operation for congenital aortic stenosis complicated by destructive infective endocarditis, and (5) inadvertent coronary artery injury during heart operation. Direct coronary reimplantation (coronary transfer) in most and surgical angioplastic procedures in selected patients were the first choice; however, PCABS with internal thoracic artery (ITA) grafts can be lifesaving in emergency or severe myocardial hypoperfusion conditions. Because the patency of saphenous vein grafts is poorer than that of ITA grafts, their use should be avoided in growing children. The procedure can be performed safely in neonates, infants, and small children, using high-power magnifying glasses or a surgical microscope.

CONCLUSIONS

Long-term results of survival and ITA graft function are excellent in growing children and adults. Congenital heart surgeons should be trained in quick graft takedown and in coping with emergency and late devastating complications in coronary transfer operation.

Internal mammary artery to coronary artery bypass in paediatric cardiac surgery

The internal mammary artery is regarded as the optimal conduit for coronary artery bypass grafting in adults. Use of this conduit in paediatric surgery is rare and has been reported mainly in patients with Kawasaki's disease. We report five patients who required internal mammary-coronary artery grafting due to adverse anatomical disposition of the coronary artery. In two cases an internal mammary graft was required during correction of transposition of the great arteries. The other cases involved correction of a left coronary artery arising anomalously from the pulmonary artery. Late angiography shows satisfactory growth and patency of the conduits.