Anomalous Coronary Arteries

Question 1

Anomalous left coronary

arising from the ?

Answer 1

pulmonary artery

Question 2

During the early postnatal period, elevated pulmonary vascular resistance results in antegrade perfusion of the anomalous coronary artery with desaturated blood. As pulmonary vascular resistance drops during the first few weeks of life, what are the next things that happen?

Answer 2

Blood shunts from the anomalous coronary artery into the PA.
> Results in decreased perfusion of the LCA system.
> LV Ischemia
> LV Failure
> LV Dilation
> Mitral Insufficiency

Question 3

What must be ruled out in any patient who presents with severe Left Ventricular Dilation & Mitral Insufficiency within the first few months of life?

Answer 3

Anomalous origin of the Left Coronary Artery.

Question 4

Surgical technique for the repair of an Anomaloous Left Coronary Artery.

Answer 4

Re-implantation preferred when possible.
Option 1.) Aortopulmonary window creating a tunnel that leads to the orifice of the anomalous coronary ostium.
Option 2.) Baffle

Question 5

Increase in activity for a month old baby cause him lots of pain and eventually cause him to become cyanotic and pass out. What could possibly be happening?

Answer 5

anomalous coronary artery into the PA is causing ischemia to the LV, which in turn causes pain.

Question 6

Name the condition in which a coronary artery is connected to a low pressure system such as the RV?

Answer 6

Coronary Artery Fistula

Question 7

If a patient undergoing an MVR with a current condition of a vascular ring double aortic arch what should be one of the most important things to assess, why?

Answer 7

Assess that Aortic annulation is supplying both head vessels not just one. This is a Major concern so confirm with TEE or cerebral saturation monitoring.

Question 8

Describe how to relieve systemic outflow tract obstruction in a single ventricle type anatomy using the DAMUS-KAYE-STANSEL procedure?

Answer 8

1. ) PA is divided proximal to its bifurcation of its Left and Right branches.
2. ) Distal PA is closed with a patch.
3. ) Proximal PA is connected to the Aorta
4. ) Pulmonary blood supply provided with a modified BT shunt.

Question 9

Describe the DAMUS-KAYE-STANSEL procedure for transposition of the great vessels?

Answer 9

current anatomy:
LV > Main PA
RV > Ascending Aorta

Repair:

1. ) LV > Main PA > End-to-side anastomosis to Aorta
2. ) Patch closure of the aortic orifice.
3. ) (Rastelli Repair) conduit from RV > distal PA

Question 10

Describe the JATENE OPERATION for D-Transposition of the great vessels.

Current Anatomy ?
Surgical Repair ?

Answer 10

Current anatomy?
RV > Aorta
LV > PA

Surgical Repair ?

Separate the vessels from the ventricles and reconnect appropriate vessels to appropriate ventricles keeping the coronaries in consideration and connecting them to the Aorta.

Question 11

During the JATENE Operation, does the Aorta end up in front of or behind the Pulmonary arteries?

Answer 11

Behind the Pulmonary Arteries

Question 12

Describe the MUSTARD operation to repair transposition of the Great Vessels?

Answer 12

Arterial Switch with a Mustard Baffle that allows Systemic venous return to flow into the LA > LV > & PA.

Pulmonary Veins > RA >RV > Aorta

Question 13

During the DAMUS-KAYE-STANSEL procedure , does the Aorta end up in front of or behind the Pulmonary arteries?

Answer 13

In Front