Abstract
Coronary complications in patients with transposition of the great arteries (TGA) after an arterial switch operation (ASO) are relatively rare, but of all the possible postoperative adverse events, they are potentially the most dangerous. The fate of the coronary arteries, which are transplanted during the neonatal ASO, remains uncertain. There is also no consensus regarding their postoperative evaluation, especially in asymptomatic patients. The aim of this study was to present the early results of routinely performed coronary computed tomography angiography (CCTA) in asymptomatic adolescents and young adults with TGA after an ASO. An initial series of 50 CCTAs performed in asymptomatic patients with TGA after an ASO were evaluated. In each case, a detailed examination of the coronary anatomy, its relationship to the surrounding structures, its exact position in the neoaortic sinus, and the presence of significant coronary abnormalities was performed. The CT scans revealed significant coronary abnormalities in 12 asymptomatic patients: three had acute proximal angulation and stenosis, four had an intra-arterial course, seven had a muscular bridge, one had a left anterior descending artery with an intramuscular course, and one had coronary fistulas to the pulmonary arteries. Additionally, in 25 patients, proximal acute angulation of at least one coronary artery was detected, and four of them had a high ellipticity index. Most of the potentially severe anatomical features were related to the left coronary artery or the left anterior descending artery. CCTA routinely performed on asymptomatic patients with TGA after an ASO provides accurate and useful information for postoperative management. The frequency of coronary anomalies and potentially dangerous anatomical features in this group of patients is high, and their impact on postoperative follow-up remains unknown.
Highlights
The successful transfer of coronary arteries is a crucial part of the arterial switch operation (ASO), which is currently the treatment of choice for patients with transposition of the great arteries (TGA)
The aim of this study was to assess the results of an initial series of coronary computed tomography angiography (CCTA) examinations that were routinely performed in asymptomatic patients with TGA after an ASO
35 patients had isolated TGA (70%); in our entire study population of patients after the ASO, isolated TGA was identified in 61% (457/750), but the difference was not statistically significant (p = 0.202)
Summary
The successful transfer of coronary arteries is a crucial part of the arterial switch operation (ASO), which is currently the treatment of choice for patients with transposition of the great arteries (TGA). The presence of complex coronary anatomy is still challenging and sometimes requires modifications related to the targeted sinus and location of coronary artery reimplantation. There is a need to keep the proximal pattern of the coronaries as close to the original pattern as possible to avoid potential curved and kinking stenosis. The postoperative development of the coronary arteries is uncertain, and there is no consensus or guidelines regarding routine coronary evaluation during the postoperative observation period [1,2,3,4], especially in the case of their direct. Mortality after an ASO is mostly related to coronary complications; in the late follow-up period, these complications are relatively rare, but they are still present in every large cohort of patients. The early identification of those patients is important for the selection of a high-risk group of patients who need to be evaluated more frequently
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