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Post-Truncal Valve Re-replacement Impingement Of Left Coronary Artery Salvaged By Coronary Artery Reimplantation
Manan H. Desai, Aybala Tongut, Can Yerebakan, Tacy Downing, Yves d'Udekem.
Children's National Medical Centre, Washington, DC, USA.
Objective(s): We present a successful salvage after a situation wherein we could not wean a patient of cardiopulmonary bypass after upsizing for the truncal valve prosthesis.
Methods:A 12-year-old patient with a repaired Truncus arteriosus present with increasing gradients across the prosthetic truncal valve that was placed 2 years of age. We replaced a previous 19 St Jude aortic valve with a 23 St. Jude aortic valve. At the conclusion of the procedure, the patient had ventricular fibrillation every time we weaned off cardiopulmonary bypass. Epicardial echo demonstrated impingement of left coronary artery at annulus.
Results: We resumed bypass and dissected the promixal left main. The left main was divided and prepared for reimplantation. The sinus was fragile and replaced with Cardiocel. We reimplanted the coronary artery in the new sinus and could wean off the bypass.
Conclusions: Lessons learned from coronary artery reimplantation helped us salvage a situation where the coronary artery was impinged upon by the prosthetic aortic valve
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