A Rare Case of Late LAD Reimplantation after Arterial Switch Operation

Yannick Kabulo Kolela,Thierry Sluysmans,Alain Poncelet,Maureen Klepper,Geoffroy De Beco

doi:10.32604/chd.2022.017635

Abstract

Arterial switch operation (ASO) is a complex neonatal operation in which transfer of the coronary arteries origins is the key to success. Coronary events after a successful ASO are not uncommon. We describe a rare case of a child who underwent an ASO in the neonatal period with one coronary (LAD) described as atretic left in place. At age seven, he developed myocardial ischemia due to retrograde flow with a steal phenomenon from the LAD into the pulmonary artery. The patient underwent a late LAD reimplantation. This case underscores that even very small ostia should be translocated at the time of ASO.

Highlights

Transposition of the great arteries (TGA) is a congenital cardiac malformation characterized by atrioventricular concordance and ventriculo-arterial discordance [1]
We describe in this article, a rare case of late left anterior descending artery (LAD) reimplantation performed seven years after an arterial switch operation (ASO)
Postoperative course was uneventful, the patient was discharge on the 6th postoperative day. This is a rare case of a child who had an ASO in the neonatal period with one coronary artery implantation and one coronary artery (LAD) described as atretic left in place

Summary

Introduction

Transposition of the great arteries (TGA) is a congenital cardiac malformation characterized by atrioventricular concordance and ventriculo-arterial discordance [1]. The arterial switch operation (ASO) has become the preferred surgical procedure for transposition of the TGA in neonates This operation is performed with a low mortality rate in many institutions. We describe in this article, a rare case of late left anterior descending artery (LAD) reimplantation performed seven years after an ASO. This case presents a similar patho-physiology to the anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) syndrome, characterized by a «coronary steal» phenomenon with a retrograde perfusion of LAD toward the pulmonary artery (due to low blood pressure in the pulmonary artery) resulting in left ventricular hypoperfusion [3].

Case Presentation

Discussion

Conclusion