Surgical angioplasty of the main coronary arteries in children

Objective: To determine the safety and efficacy of surgical angioplasty of the coronary arteries In children. Methods: We performed 9 surgical reconstructions of the left main corollary artery and I of the right coronary artery ostium in 10 children (mean age 5.7 years; range 2 months-15 years), The basic diseases included the following: congenital atresia of the left coronary artery (n = 2) and atl es;la of the right coronary artery in a patient with an aortoventricular tunnel (n = 1); stenosis of the left main coronary artery (1) in a patient with Williams syndrome (n = 1), (2) in a patient with familial hypercholesterolemia (n = 1), (3) after the arterial snitch operation for transposition of the great arteries (n = 3), (4) after reimplantation of an anomalous left main coronary artery from the pulmonary artery (n = 1), and (5) by compression after a reparation a l'etage ventriculaire procedure (n = 1). Myocardial viability was assessed by single photon emission computed tomography (thallium 201; 7/10), The coronary artery stem was enlarged with a saphenous (n = 5)? a pericardial (n = 4). or a polytetrafluoroethylene patch (n = 1), Results: There was 1 hospital death and 9 patients are alive (mean follow-up 46 +/- 30 months; range 12 months to 10.5 years). Eight of 9 survivors had a selective coronary artery angiogram and had normal coronary artery ostia, Two patients had stenosis of the left anterior descending coronary artery, 1 of whom underwent successful internal thoracic artery grafting. Conclusions: Surgical angioplasty of the coronary stems restores physiologic coronary perfusion and conserves bypass material. It can be performed safely in children and provides encouraging midterm results.