Subscribe to RSS
DOI: 10.1055/s-2005-862149
Myocardial revascularization with the internal thoracic artery for myocardial ischemia during arterial switch operation
Objectives: Coronary transfer is the most delicate part of the arterial switch operation (ASO). Inadequate perfusion of a large myocardial area results in cardiac failure. If relocation of the coronary buttons does not restore myocardial perfusion, immediate revascularisation with the internal thoracic artery (ITA) is the last surgical option.
Material and Methods: In two patients (age: 11 days and 4 months; weight: 4.4 and 4.6kg) ITA bypass for the right or left coronary artery was performed. Patient 1 had simple D-TGA with a single coronary ostium and intramural course of the RCA, which could not be transferred adequately and was bypassed with the right ITA. Patient 2 had DORV with complete TGA and VSD and underwent ASO with Rastelli. After coronary transfer, the left coronary was not perfused so that a left ITA was performed on the LAD.
Results: Patient 1 was weaned off bypass uneventfully, patient 2 recovered well after 4 days ECMO support. The patients were extubated on postoperative day 3 and 14, respectively; ICU stay was 9 and 20 days, respectively. There were neither remarkable elevations of myocardial markers nor abnormalities in ECG; echocardiography showed normal EF in both without regional wall motion abnormalities at discharge and at follow-up after 8 and 14 months. Cardiac cath showed complete bypass dependent perfusion of the RCA in patient 1 and orthograde and bypass perfusion in patient 2. Clinical status of both is excellent.
Conclusions: Myocardial revascularisation with the ITA can restore myocardial perfusion in ASO after failed coronary transfer with excellent results.