日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

The cause of perioperative coronary-related complications in congenital heart surgery is either procedure-related or an attribute of the disease itself. The representative example of the former is an arterial switch operation for the transposition of the great arteries or double outlet right ventricle. In performing safe and adequate coronary transplantation, careful observation of not only the coronary patterns but also coronary transplantation method, spatial relationship of the great arteries, and the method of pulmonary artery reconstruction are comprehensively considered. In contrast, an example of the latter is pulmonary atresia with an intact ventricular septum associated with the right ventricle-coronary sinusoidal communication. To avoid perioperative coronary ischemia, special attention must be paid to intraoperative management, including the perfusion and operative methods. In addition to obtain a precise preoperative diagnosis and careful intraoperative observation, the awareness about the fact that many congenital heart diseases could have a coronary anomaly may help to avoid coronary-related complications in congenital heart surgery.