To the Editor:
I read with interest the paper by Manoly and colleagues1 about their coronary extension technique, whereby they used a strip of pulmonary artery anteriorly and an aortic flap posteriorly in a 19-year-old woman who had Bland-White-Garland syndrome. Although our paper was not cited, my colleague and I had described this technique in 1992. We used it in a 21-month-old girl whose anomalous left coronary artery (LCA) arose from the anterior sinus of the pulmonary trunk.2 Because the patient's aortic defect was rather small, we did not patch it.
I want to report on the long-term outcome in our patient. An aortogram showed an unobstructed LCA when she was 5 years old. Catheterization data at that time showed no significant pressure gradient in the right ventricular outflow tract (right ventricular pressure, 40/6 mmHg; pulmonary artery pressure, 36/13 mmHg). The patient is now 28 years old and is doing well, without symptoms or reoperation. This method, which we now call the double-flap method, produced good early and long-term results and is a useful adjunctive procedure for 2-coronary-system reconstruction when the LCA ostium is distant from the aorta.
References
- 1.Manoly I, Karangelis D, Viola N, Haw M. Repair of Bland-White-Garland syndrome via a modified technique. Tex Heart Inst J. 2014;41(1):48–50. doi: 10.14503/THIJ-12-3112. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Sese A, Imoto Y. New technique in the transfer of an anomalously originated left coronary artery to the aorta. Ann Thorac Surg. 1992;53(3):527–9. doi: 10.1016/0003-4975(92)90290-k. [DOI] [PubMed] [Google Scholar]