Anatomic Repair of Left Main Coronary Artery Atresia: Coronary Ostioplasty With Autologous Pulmonary Artery

Left main coronary arterial (LMCA) atresia is a rare coronary arterial anomaly with extremely limited data on the optimal management. We aimed to report our single-surgeon experience of the ostioplasty in patients with LMCA atresia. From July 2018 to December 2019, pediatric patients who presented with LMCA atresia and subsequently underwent surgical coronary ostioplasty were recruited into this retrospective study. Concomitant mitral repair was applied when the regurgitation was moderate or more severe. A total of 9 patients diagnosed with LMCA atresia were included. Mitral regurgitation was found in all of them, including 6 (66.7%) severe, 1 (11.1%) moderate, and 2 (22.2%) mild. In addition to ischemic lesions, which were found in 7 (77.8%) patients, structural mitral problems were also common (presented in 7 [77.8%] patients). All the patients underwent coronary ostioplasty with autologous pulmonary arterial patch augmenting the anterior wall of the neo-ostium. Mean aortic cross clamp time and cardiopulmonary bypass time was 88.1 ± 18.9 and 124.6 ± 23.6 minutes, respectively. During a median of 10.9 (range: 3.3 to 17.2) months' follow-up, there was only 1 death at 5 months after surgery. All survivors were recovered uneventfully with normal left-ventricular function; however, with 4 (50.0%) having significant recurrence of mitral regurgitation. With favourable surgical outcomes, coronary ostioplasty for LMCA atresia may be an option of revascularization. Structural mitral problems presented in majority patients, resulting in the requirement of concomitant mitral repair. However, the optimal technique of mitral repair remains unclear. L’atrésie de l’artère coronaire principale gauche (ACPG) est une anomalie coronarienne rare, dont la prise en charge optimale est très mal connue. Nous rapportons ici les résultats d’ostioplasties pratiquées par un même chirurgien chez des patients atteints d’atrésie de l’ACPG. Les enfants présentant une atrésie de l’ACPG et ayant subi une ostioplastie coronaire entre juillet 2018 et décembre 2019 ont été admis dans cette étude rétrospective. Les patients qui présentaient une insuffisance modérée ou plus sévère ont aussi subi une réparation mitrale en même temps. Au total, neuf patients ayant reçu un diagnostic d’atrésie de l’ACPG ont été inclus dans l’étude. Tous présentaient une insuffisance mitrale, qui était sévère chez six patients (66,7 %), modérée chez un patient (11,1 %) et légère chez deux patients (22,2 %). Outre