A case of arterial switch operation with coronary elongation technique.

Tomoyuki Matsuba,Itsumi Imagama,Yutaka Imoto,Yoshiya Shigehisa

doi:10.1186/s40792-016-0134-9

Abstract

A 28-day-old infant with d-transposition of the great arteries underwent arterial switch operation. The coronary pattern was Yacoub type A, in which coronary transfer is usually thought to be easy. However, a dominant conus branch diverged from the proximal portion of the left coronary artery (LCA). Moreover, the LCA ostium itself was near the remote commissure in sinus 1, very far from the target re-implantation point. All of these conditions made LCA transfer very difficult. We used a coronary elongation technique to solve this problem. An inverted U-shaped flap was made in the wall of the neoaorta, and the LCA cuff was anastomosed to this flap (the inferior half from the neoaortic flap and the superior half from the LCA cuff). To prevent compression of the LCA, the neopulmonary trunk was shifted rightward. Postoperative echocardiography showed good left ventricular wall motion, and the LCA was easily visualized on chest computed tomography, with no compression from the neopulmonary artery.

Highlights

Coronary artery transfer without kinking or overstretching is the key to a successful arterial switch operation (ASO)
We present such a case, in which the gap between the left coronary artery (LCA) orifice and the neoaorta could not be bridged with usual mobilization of the LCA because of other anatomical characteristics
ASO was successfully performed with a coronary elongation technique for the LCA

Summary

Introduction

Background Coronary artery transfer without kinking or overstretching is the key to a successful arterial switch operation (ASO). Anatomical variation of the coronary arteries, such as a single coronary orifice as in a Yacoub type B coronary pattern, with or without the intramural coronary artery, is considered a surgical risk [1,2,3,4,5]. Even with a normal coronary artery pattern, coronary transfer can be difficult in some cases. We present such a case, in which the gap between the left coronary artery (LCA) orifice and the neoaorta could not be bridged with usual mobilization of the LCA because of other anatomical characteristics.

Results

Conclusion