LETTER TO THE EDITOR
Major coronary artery anomalies in the pediatric population
Alexander Davidson, MDa and
Tom R. Karl, MDa
a The Cardiac Center, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Suite 8527, Philadelphia, Pennsylvania 19104, USA
davidson{at}tuhs.temple.edu
We read with interest the article by Davis et al. (1). The investigators nicely address the problems related to the identification and treatment of these rare coronary anomalies. Although agreeing with the indications for intervention, we believe that aortocoronary bypass grafting may not be the optimal treatment. The long-term patency of arterial grafts (78% at 10 years for internal thoracic artery grafts in the treatment of young patients after Kawasaki disease) (2) may not be satisfactory for children. In addition, given that most of the time the flow through the affected coronary is unimpeded, the graft sets up a competitive flow, which might jeopardize long-term patency. We have taken a different approach, adapted from the translocation of intramural coronary arteries during the arterial switch operation for transposition of the great arteries. The inner wall of the sinus of Valsalva along the intramural portion of the artery is excised to enlarge the ostium. An autologous pericardial patch is used to enlarge the proximal portion of the artery on its external aspect. This is readily accomplished by transection of the aorta and pulmonary artery to obtain a good exposure. This strategy eliminates the acute takeoff angle and external compression of the anomalous coronary, while avoiding competitive flow through a graft, and thus may result in better long-term patency than aortocoronary bypass. We offer this as an alternative to the use of aortocoronary bypass or internal thoracic artery grafting.
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References
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1. Davis JA, Cecchin F, Jones TK, Portman MA. Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol. 2001;37:593–597[Abstract/Free Full Text]
2. Yoshikawa Y, Yagihara T, Kameda Y, et al. Results of surgical treatment in patients with coronary-arterial obstructive disease after Kawasaki disease. Eur J Cardiothorac Surg. 2000;17:515–519[Abstract/Free Full Text]
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