Coronary Artery Bypass in Infants with Left Main Coronary Artery Atresia Using an Internal Thoracic Artery Bypass Graft

TYPE: Abstract TOPIC: Cardiothoracic Surgery PURPOSE: To observe the safety, efficacy and long-term patency of ITA grafts in INFANT LMCA METHODS: We performed a retrospective review of three infant cases of LMCA where ITA to LAD bypass graft was performed. Follow-up was up to 13 years. RESULTS: 7 week infant presented with heart failure and mitral insufficiency(MI). Echocardiography confirmed MI and echobright papillary muscles. Angiography confrimed LMCA. ITA to LAD graft was performed with mitral valve repair. Recovery was uncomplicated and echocardiography showed good function with mild MI. Angiography after 7 months showed good function, patent ITA graft and no MI. MRA in July 2021 shows normal function, no MI, and widely patent ITA graft. 7 week male presented with heart failure and MI. Echocardiography showed echobright papillary muscles and ALCAPA was suspected. Angiography diagnosed LMCA. ITA to LAD graft was performed with mitral repair. Clinical recovery was uncomplicated however the MI deteriorated. With medical management the insufficiency reduced to mild. Angiography confirmed ITA patency and good function 8 months after surgery. He remains well with normal function 8 years post surgery. 5 month infant presented with a murmur. ALCAPA was suspected on echocardiography. CTA was inconclusive . Angiography diagnosed LMCA. ITA to LAD bypass graft was performed and the patient discharged on post op day 3. A predischarge CTA showed widely patent ITA graft filling the LAD. CONCLUSIONS: 1. ITA graft is a safe in infancy. 2. Long term patency and growth is confirmed 3. MI improves after revascularization CLINICAL IMPLICATIONS: The ITA is sufficient for complete revascualrization in LMCA with excellent long term results. DISCLOSURE: Nothing to declare. KEYWORD: Infant ITA Bypass Graft