Pericardial Tube for Translocation in Anomalous Origin of Coronary Arteries To the Editor: We read with great interest the work by Wu and Xu [1] and we would like to add comments to the discussion. Remote left coronary artery (LCA) has always been a serious problem in patients with anomalous origin of the LCA from pulmonary artery (ALCAPA). Many surgeons have devised various modifications to elongate a remote LCA [2]. The authors proposed using the pulmonary artery wall as a tube to elongate the LCA. A similar method with good outcomes for more than 5 years of follow-up has been published [3, 4]. We used a similar idea to solve different coronary problems in 4 patients by constructing a tube graft with autologous pericar- dium. The pathology was ALCAPA with remote LCA in 2 patients. The other patients had transposition of the great arteries (TGA) with an inverted coronary artery pattern; one of them also had an intramural course. All patients had uneventful recoveries. Two patients (1 with ALCAPA, another 1 with TGA) had coronary angiography 5 years after operation. The tube grafts were widely open, and the coronary circulation was intact (Fig 1). Total follow-up is now 5 to 11 years. No wall motion abnormality has been detected by echocardiography, and exer- cise stress tests are normal. We prefer using a pericardial tube to avoid removing tissue from the great arteries to establish a normal coronary circulation with optimal anatomy. We suggest that autologous pericardium can be used to construct the tube graft with good early-term and long-term patency. We believe that elongation of the coronary artery with a tube graft facilitates transfer to the aorta in various surgical procedures, and we recognize that all types of autolo- gous material can be used with satisfactory results. Tayyar Sarioglu, MD Ece Salihoglu, MD Ersin Erek, MD Yusuf Kenan Yalcinbas, MD Cardiovascular Surgery Department Acibadem Heart Center Acibadem Bakirkoy Hospital Halit Ziya Usakligil cad. No. 1 Istanbul, 34140 Turkey e-mail: salihogluece@yahoo.fr References 1. Wu Q, Xu Z. An alternative procedure for correction of anomalous origin of left coronary artery from the pulmonary artery. Ann Thorac Surg 2007;84:2132–3. 2. Tsang VT, Stark J. Congenital coronary artery fistula and anomalous origin of the left coronary artery from the pulmo- nary artery. In: Stark JF, De Leval MR, Tsang VT, eds. Surgery for congenital heart defects, 3rd edit. West Sussex: John Wiley & Sons, 2006:609 –19. 3. Turley K, Szarnicki RJ, Flachsbart KD, Richter RC, Popper RW, Tarnoff H. Aortic implantation is possible in all cases of anomalous origin of the left coronary artery from the pulmo- nary artery. Ann Thorac Surg 1995;60:84 –9. 4. Barth MJ, Allen BS, Gulecyuz M, Chiemmongkoltip P, Cuneo B, Ilbawi MN. Experience with an alternative technique for the management of anomalous left coronary artery from the pulmonary artery. Ann Thorac Surg 2003;76:1429 –34. Reply To the Editor: I would like to thank Sarioglu and colleagues [1] for their feedback and points to our article [2]. We used the pulmonary artery wall to create a tube to elongate the left coronary artery in regard to it retaining the growth possibility, and this is especially important for good long-term outcome. Congratu- lations to your good results in treating similar patients with autologous pericardium. Did you use it fresh or glutaralde- hyde preserved? Theoretically, a tube made with fresh peri- cardium more possibly gets deformed; for the glutaraldehyde preserved pericardium, it is more vulnerable to degeneration and calcification in a long period. That is our concern. So we may need more patients and longer follow-up time for these patients. Qingyu Wu, MD First Hospital of Tsinghua University Cardiac Center School of Medicine Tsinghua University No. 6 JiuXianQiao 1st Rd Beijing, 100016 China e-mail: wuqingyu@mail.tsinghua.edu.cn References 1. Sarioglu T, Salihoglu E, Erek E, Yalcinbas YK. Pericardial tube for translocation in anomalous origin of coronary arteries (letter). Ann Thorac Surg 2008;86:1722. 2. Wu Q, Xu Z. An alternative procedure for correction of anomalous origin of left coronary artery from the pulmonary artery. Ann Thorac Surg 2007;84:2132–3. Fig 1. Postoperative fifth year angiography in a patient with anom- alous left coronary artery from the pulmonary artery. 1722 CORRESPONDENCE Ann Thorac Surg 2008;86:1721–5 © 2008 by The Society of Thoracic Surgeons 0003-4975/08/$34.00 Published by Elsevier Inc MISCELLANEOUS