Abstract
Asymptomatic coronary artery obstruction represents a significant diagnostic challenge in patients with Dextro-Transposition of the Great Arteries and history of Arterial Switch Operation. We report the case of a 17-year-old boy with anomalous origin of left circumflex artery from the right coronary artery, who underwent neonatal arterial switch operation and developed silent myocardial ischemia under stress on myocardial scintigraphy. Despite coronary angiogram and intravascular ultrasound showed only intermediate stenosis of the right coronary artery ostium, the physiological analysis, through the employment of pressure wire, demonstrated a severe reduction of coronary fractional flow reserve after pharmacologically induced hyperemia. Thus, the patient was treated with implantation of drug eluting stent. Invasive fractional flow reserve of coronary stenosis may represent a useful tool to guide revascularization strategy in this population.
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