Indication of Takeuchi Technique for Patients With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

Abstract

Background: Intrapulmonary tunnel repair, called the Takeuchi technique, is a unique procedure for repairing anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Since 1986, we have clearly defined the indication for the Takeuchi technique based on the location of the left coronary artery (LCA) orifice. Methods and Results:From 1986 to 2011, 19 consecutive patients with ALCAPA underwent surgical repair; the dual-coronary system was reconstructed in 16 of these patients with either Takeuchi (n=9: 1 male; median age 14.7 years; median weight 42.7 kg) or a translocation procedure (n=7, 3 males; 0.4 years old, 5.6 kg). Takeuchi was performed in patients whose LCA arose far from the aorta (middle of posterior facing sinus in 3 patients, left side of posterior facing sinus in 2, non-facing sinus in 4). The mean postoperative follow-up period was 7.4±6.1 years in the Takeuchi group and 9.3±8.5 years in the Translocation group. Actuarial survival rate at 10 years was 87.5% and 71.4%, respectively, and the freedom from either reoperation or re-intervention rate at 10 years was 67.7% and 85.7%, respectively. All the patients who died had a preoperative left ventricular ejection fraction ≤30%. Conclusions:The long-term outcome of the Takeuchi technique was acceptable. Although late reoperation and/or re-intervention cannot be disregarded, Takeuchi can be recommended when the LCA arises far from the aorta. (Circ J 2013; 77: 1202 -1207

A case of robotic assisted percutaneous coronary intervention of the left main coronary artery in a patient with very late baffle stenosis after surgical correction of anomalous left coronary artery from the pulmonary artery

“…However, this was not seen in this case. Although baffle stenosis treated by angioplasty has been reported in two cases, these were performed within few months after the operation . Since previous studies were limited by relatively shorter follow up (mean 15.9 years) after surgical correction, very late complication seen in our patient (34 years) has not been reported previously, and the mechanism of late stenosis remains unclear.…”

“…Reported mortality without surgical correction is 90% and two surgical correction strategies include Takeuchi repair and coronary artery translocation (Figure ). Although coronary translocation is performed more often in recent years, Takeuchi repair used to be the operation of choice especially when the ostium of anomalous LMCA is further away from the aorta as it has better reach by utilizing a baffle through the pulmonary artery . Reported late complications of Takeuchi repair include, pulmonary stenosis, mitral regurgitation, baffle leak and reduced ejection fraction .…”

The outcome of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in infants

“…There are different surgical techniques for repair. The coronary transfer is the current technique of choice for the repair of ALCAPA [9], and it has an acceptable survival rate [10]. In this study, two patients underwent the Takeuchi procedure, and three patients had LCA reimplantation to the aorta and patch PA repair.…”

A rare case of anomalous origin of the left anterior descending artery from the pulmonary artery

“…is baffle leak and pulmonary stenosis. 9,10 Currently, the translocation procedure aims to establish the dual-coronary system and has become more popular with satisfactory outcome. In our case, surgery was highly recommended even though the patient showed no obvious myocardial ischemia at the time of admission.…”