Rescue of Coronary Injury with Right Internal Mammary Artery Bypass during Repair of a Complex Congenital Heart

A 10-year-old boy with polysplenia syndrome was diagnosed with complex congenital heart disease, including common atrium, bilateral superior vena cava, complete atrioventricular canal defect, severe pulmonary stenosis, interrupted inferior vena cava, and patent ductus arteriosus. Previously, he underwent a bilateral bidirectional Glenn shunt operation with ligation of the patent ductus arteriosus in April, 2009, when he was six years old. During the operation, his left anterior descending coronary artery (LAD) was injured accidently due to abnormally high coronary artery takeoff. Consequently, a coronary artery bypass graft [right internal mammary artery (RIMA) to LAD proximal, end-to-end] was performed. On July 24, 2013, he received the last stage of a total cavopulmonary connection with an extracardiac conduit (22 mm PTFE graft) at ten years of age. The RIMA was not injured during redo-sternotomy and he was discharged uneventfully 11 days after the operation.