origem anômala pulmonar da artéria coronária esquerda com trajeto intramural aórtico: diagnóstico e tratamento cirúrgico

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ID: 210683
1998
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Abstract
Cinco pacientes com idades entre 3 meses e 11 meses, com diagnóstico clínico, ecocardiográfico e angiográfico de origem anômala da artéria coronária esquerda do tronco pulmonar foram operados no período de 1987 a 1997. Somente durante o ato operatório foi diagnosticado o trajeto intramural aórtico. Em 4 deles uma nova técnica cirúrgica foi utilizada e em 1 deles o reimplante da coronária esquerda foi empregado. Nesta técnica, após o diagnóstico intra-operatório do trajeto intramural, o tronco pulmonar é aberto e a coronária esquerda é explorada com um probe de modo a identificar seu trajeto. A seguir, a aorta é aberta e o segmento intramural da coronária é aberto longitudinalmente. A camada íntima da coronária é suturada à íntima e média da aorta, criando-se uma ampla janela aortocoronária. Por último, a origem da coronária anômala no tronco pulmonar é ligada. Os 4 pacientes operados com esta técnica evoluíram com melhora da classe funcional e da função contrátil ao ecocardiograma. Apresentam-se em classe funcional grau I (NYHA) após um período de seguimento de 7 meses a 10 anos. O único óbito ocorreu no paciente submetido a dissecção da coronária esquerda e reimplante na aorta, que apresentou complicações pós-operatórias, falecendo 6 meses após a alta hospitalar. Nestes casos, a tentativa de separar a coronária da parede aórtica e reimplantar a coronária deve ser evitada. A técnica descrita permite a correção cirúrgica desta anomalia de maneira simples e segura, com bons resultados a longo prazo.
Five patients with anomalous connection of the left coronary artery to the pulmonary artery by an intramural route, whose ages ranged from 3 months to 11 months, were operated from 1987 to 1997. The diagnosis of the intramural aortic route was only made during the operation. In 4 patients a new technique was used. After establishment of the intramural aortic route, the pulmonary trunk was opened and the left coronary artery explored with a probe in order to identify its traject. Then, the aortic wall was opened and the intramural portion of the left coronary artery was opened longitudinally. The intima of the coronary artery was sutured to the intima and media layer of the aortic wall, creating an aortocoronary window. Finally, the origin of the left coronary was ligated. These 4 patients were followed-up from a period of 7 months to 10 years. They present clinical and echocardiographic improvement. All are in functional class I (NYHA), without medication. The only death occured 6 months after the operation. In this patient the intramural portion of the left coronary artery was divided from the aortic wall and the coronary artery reimplanted. There was several postoperative complications and the patient died suddenly 6 months after the operation. In this anomaly, the attempt to separate the left coronary artery from the aortic wall must be avoided. The described technique permits a safe and simple surgical correction of this rare anomaly, with good long-term results.
Reference Key
barbero-marcial1998brazilianorigem Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Miguel BARBERO-MARCIAL;Carla TANAMATI;Edmar ATIK;Luiz KAJITA;Munir EBAID;Marcelo B. JATENE;Adib D. JATENE
Journal 2017 international conference on information technology systems and innovation, icitsi 2017 - proceedings
Year 1998
DOI
10.1590/S0102-76381998000200004
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76381998000200004
Keywords
aorta pulmonary artery cardiovascular surgical procedures coronary vessel anomalies

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