Aortic re-implantation in a case of anomalous origin of the left coronary artery from the right pulmonary artery in a toddler.

This tutorial  demonstrates correction of the rarest congenital coronary anomaly, anomalous origin of the left coronary artery from the right pulmonary artery (ALCAPA RPA). We present the features of surgical repair in the case of a toddler patient with an associated atrial septal defect.

Anomalous origin of the right coronary artery from the pulmonary artery: surgical re-implantation into the aorta.

Anomalous origin of the right coronary artery from the pulmonary artery is rare (only 200 cases have been reported in total), potentially life-threatening and with an uncertain prognosis. Patient characteristics are only available in half the reported cases. Easy to miss, anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is usually diagnosed in association with concomitant cardiac anomalies. Techniques for its correction are rarely discussed, but the restoration of a two-coronary system is optimal. We report details of the surgical repair of ARCAPA in a 17-year-old man to highlight important anatomical features.

The Bex-Nikaidoh operation for dextro-transposition of the great arteries with a ventricular septal defect and pulmonary stenosis using an 'oversized' conduit.

We report a case of a 4-month-old infant with dextro (d)-transposition of the great arteries, ventricular septal defect (VSD) and left ventricular outflow tract obstruction previously palliated with a systemic-to-pulmonary shunt. He underwent repair by aortic root translocation with an arterial switch procedure and coronary artery reimplantation (modified Bex-Nikaidoh operation). This case demonstrates that aortic translocation results in a more normal anatomic repair compared with the Rastelli operation. As shown, it is always possible to place an oversized conduit (homograft) and there is no risk of sternal compression of the conduit. This is especially important for children under 1 year, when there are contraindications for the Rastelli operation. Placement of oversized pulmonary ventricle-pulmonary artery conduits is performed to decrease conduit failure in the future. The postoperative course was uneventful. At 6 months, he was asymptomatic with tomographic images and echocardiography showing no residual lesions.