RESUMO
Recurrent angina after coronary artery bypass grafting is rarely caused by left subclavian artery (LSCA) stenosis resulting in reduced left internal mammary artery blood flow. We present 2 cases of coronary-subclavian artery steal syndrome resulting from LSCA stenosis and their successful surgical management with left carotid to LSCA bypass. Based on the successful management described in this case report, and the limitations of other options in addressing coronary-subclavian artery steal syndrome, left carotid to LSCA bypass surgery should be considered for revascularization in patients who develop postoperative coronary-subclavian artery steal syndrome due to LSCA stenosis.
La récidive d'angine après le pontage aortocoronarien est rarement causée par la sténose de l'artère sous-clavière gauche (ASCG) entraînant la réduction du débit sanguin de l'artère mammaire interne. Nous présentons deux cas de syndrome du vol coronaro-sous-clavier résultant de la sténose de l'ASCG et la réussite de leur prise en charge par pontage entre l'artère carotide gauche et l'ASCG. Compte tenu de la réussite de la prise en charge décrite dans cette observation et des limites des autres options dans le traitement du syndrome du vol coronaro-sous-clavier, le pontage entre l'artère carotide gauche et l'ASCG devrait être envisagé lors de la revascularisation des patients qui présentent le syndrome du vol coronaro-sous-clavier postopératoire en raison de la sténose de l'ASCG.
RESUMO
BACKGROUND: We reported our experience in managing patients with single ventricle (SV) physiology and increased pulmonary blood flow (PBF), aiming to assess if it is feasible to proceed with primary Bidirectional Glenn (BDG) without a prior operation to limit PBF. MATERIALS AND METHODS: This is a retrospective study with 51 consecutive patients who underwent BDG operation as a primary operation or a second stage prior to the definitive Fontan operation at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia between 2010 and 2018. Patients were categorized into two groups based on their PBF prior to the operation: Patients who had SV physiology and increased PBF (seven patients) vs. patients with SV physiology and restricted PBF (44 patients). RESULTS: The median age for the increased PBF group was 9.9 months [interquartile range (IQR): 2-16.9 months], and the median age for the restricted PBF group was 15.3 months (IQR: 6.7-42.6 months). Although the length of hospital stay was longer in patients with increased PBF (P = 0.039), we couldn't find a statistically significant difference in early mortality, duration of mechanical ventilation, length of pleural drainage, and length of intensive care unit (ICU) stay between the groups. CONCLUSION: In our experience, we found that primary BDG could be done safely for patients having SV physiology and increased PBF with acceptable short-term outcomes. It might further reduce the morbidity and mortality for those patients by avoiding the risk of initial pulmonary artery banding or aortopulmonary shunts.
