Translocation of Anomalous Right Coronary Artery to Aortic Side of the Aortopulmonary Window: A Different Approach for a Rare Combination

Abstract

A case of aortopulmonary window associated with anomalous origin of the right coronary artery from the pulmonary artery in a four-month-old boy is reported in this paper with a different method of repair. In this patient, surgical repair was done by transferring the right coronary artery from the pulmonary artery to the aorta at the aortopulmonary window side. The defect at the pulmonary artery was repaired by a pericardial patch, so no other secondary opening was used for the aorta in order to reimplant the coronary artery.

Aortopulmonary Window With Anomalous Coronary Arteries

“…A pericardial baffle covering the window and coronary ostium was performed, as the rerouting procedure is simple and preserves the native implantation of the coronary artery. Alternatively, other authors have corrected this anomaly using a coronary button flap transfer . In this technique, the aortic defect is completely closed by an autologous coronary flap, whereas the defect in the pulmonary artery is closed using a separate patch.…”

Anatomical Repair of Aortopulmonary Window with Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery

“…Although the rerouting procedure is simple and preserves the native implantation of the coronary artery, a rerouting patch may create an obstruction of the right pulmonary artery in a distal or total defect type of APW. Aydin and associates have corrected a proximal type of this anomaly in a four‐month‐old infant with a technique similar to ours, closing the aortic defect by the RCA button . The combination of trapdoor and RCA flap facilitates the implantation of the RCA at the aortic defect without kinking and/or stretching especially for a distal type of APW in a small baby.…”

Reply to the Editor

“…Our group has also reported a successful surgical treatment for an infant with the same combination but with a novel technique. 2 Our patient was a 4-month-old boy who had congestive heart failure and a continuous murmur on the left sternal border. Echocardiography and angiography showed APW and RCA originating from the pulmonary trunk.…”