Is Preoperative Delineation of Coronary Artery Pattern a Prerequisite for Arterial Switch Operation?

Abstract

To determine the effect of preoperative echocardiographic delineation of coronary artery pattern on the immediate postoperative result of arterial switch procedures. A retrospective review of a consecutive series of children who underwent the arterial switch operation at a single institution from February 2001 to December 2004. Sixty-six children underwent an arterial switch operation. The median age at the time of repair was 1.17 months (range 0.2-96 months). Fifty-five patients (83%) were diagnosed to have dextro-transposition of the great arteries, and 11 patients (17%) had double outlet right ventricle of the Taussig-Bing type. Associated left-sided obstructive lesions were present in 12 cases (18.3%). The dominant coronary pattern was 1 LCX; 2R (60.6%), and followed by 1L; 2RCX (24.2%). The techniques used for coronary transfer were the trapdoor flap, circular buttonhole transfer, or combined technique in all patients except for one case. Preoperatively, the coronary artery anatomy was adequately delineated in only 26 cases (39.4%). Forty patients (60.6%) had either different coronary description or non-documented coronary artery pattern. Myocardial ischemia was not observed in any case postoperatively and no patient in the series required reoperation for coronary revision. There were 10 in-hospital deaths (15%) not related to the coronary pattern. Follow-up is available for 49 of the surviving patients (87.5%) at a mean of 10.1 months. There has been no readmission or reintervention for myocardial ischemia. The trapdoor flap and circular buttonhole techniques are the most practical and reproducible maneuvers of coronary transfer during arterial switch operation. Both techniques can compensate for inadequate preoperative echocardiographic delineation of coronary artery pattern.