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Half Pantaloon (Florida-Shaped) Patch for Repair of Anomalous Left Coronary Artery from the Pulmonary Artery

Monday, April 4, 2016

Originally presented as a Surgical Motion Picture at the 2015 STSA Annual Meeting

Objectives: The use of a pantaloon-shaped patch for repair of the pulmonary artery after coronary transfer for transposition of the great arteries (TGA) results in significantly reduced incidence of coronary compression and suprapulmonary stenosis. This video demonstrates the use of a half-pantaloon patch (Florida shaped) to create a similar pulmonary artery reconstruction after coronary transfer for ALCAPA.

Methods: A half-pantaloon patch is created from homograft material and is placed after the coronary transfer in a case of ALCAPA in a 5-month-old patient. Other technical features to facilitate this procedure are also demonstrated, such as the use of retrograde cardioplegia and suture retraction of the ascending aorta.

Results: The video demonstrates how the reconstructed pulmonary artery lies loosely over the posterior, transferred left coronary artery. The patient had an excellent clinical outcome and was discharged home one week after surgery. Left ventricular function and mitral insufficiency were slightly improved by the time of discharge. Excellent flow could be visualized by echo in the re-implanted left coronary artery.

Conclusion: Unlike repair of TGA, where coronary compression by the anterior pulmonary artery can be fatal, compression of the left coronary artery after repair of ALCAPA might not necessarily present as an acute problem. The most commonly used technique for pulmonary artery repair in ALCAPA is a sinus shaped patch. However, the results of using a large pantaloon-shaped patch in TGA repair leads the authors to believe that the posterior coronary artery and the pulmonary outflow would be better managed by applying a similar type of patch during ALCAPA repair—a technical modification that is simple to use.

Copyright 2015, used with permission from the Southern Thoracic Surgical Association. All rights reserved.

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