A variety of surgical approaches have been proposed in
adults with ALCAPA, including ligation of the LCA, reimplantation of the LCA to the aorta, creation of
an aorta pulmonary window with an intrapulmonary
buffle (Takeuchi procedure), and a combination of
LCA ligation and coronary artery bypass grafting.[
4,
5]
Recently, the first case of a giant aneurysm formation
after Takeuchi procedure was reported.[6] In this case,
a saphenous vein graft into the LCA was performed.
The reported complications of Takeuchi repair include
the development of PA stenosis at the intrapulmonary
baffle, baffle leak, decreased left ventricular function,
and mitral regurgitation.[6] Thus, late complications of
the Takeuchi procedure are common.
In 1974, Neches et al.[7] were the first to describe
the direct reimplantation of the anomalous LCA
into the aorta by transferring it with a button of PA.
However, direct reimplantation of the LCA may be
technically more challenging and hazardous in adults
due to its distant, less elastic, and friable nature of the
coronary arteries.[8] Creative methods such as direct
transfer, tubular reconstruction, and in situ transfer
can be used in adults, regardless of the site of the LCA
orifice.[9]
It is well known that ALCAPA in elderly is not
suitable for direct reimplantation, unless the orifice
of the LCA really close to the inner curvature of the
aorta, which is extremely small in the minority of
patients.[8] In this case, reimplantation of the LCA into
the aorta was considered unfeasible due to the distance
between the insertion site of the LCA on the PA and
the aorta. The main advantage of this method is that
the graft run in the anatomical groove behind the PA
through transverse sinus.
As we are aware of that the saphenous vein may
not be fully patent like the internal thoracic artery in
coronary artery bypass grafting, we used the possibly
largest conduit - a saphenous vein graft - to match the
size of the LCA in our case.
In conclusion, this technique provides tension-free
venous graft for the transfer of anomalous origin of the
left coronary artery from the pulmonary artery into the
aorta, when the anomalous left coronary artery ostium
is located at a distance from the aorta in adults.
Declaration of conflicting interests
The authors declared no conflicts of interest with
respect to the authorship and/or publication of this
article.
Funding
The authors received no financial support for the
research and/or authorship of this article.