Fate of Intramural Coronary Arteries after Arterial Switch Operation

Sachweh, Jörg S; Tiete, A.; Jockenhoevel, Stefan; Mühler, E; Bernuth, G. von; Messmer, Bruno J.; Daebritz, Sabine

doi:10.1055/s-2002-20165

Cited by 15 publications

(8 citation statements)

References 17 publications

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“…Vessel reimplantation has been described [57], but Rinaldi et al [45] reported their poor results with reimplantation, as two patients required emergency bypass grafting. In an analogous procedure, reimplantation of intramural coronaries during arterial switch for transposition of the great arteries is also associated with high occlusion rates [58]. The most promising procedure involves bunroofingQ the anomalous vessel from its intramural course, allowing modification of the slit-like ostium of the anomalous coronary, which becomes fully patent after reconstruction.…”

Section: Surgical Managementmentioning

confidence: 99%

Management of anomalous coronary arteries from the contralateral sinus

Mirchandani

Phoon

2005

International Journal of Cardiology

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Section: Surgical Managementmentioning

confidence: 99%

Management of anomalous coronary arteries from the contralateral sinus

Mirchandani

Phoon

2005

International Journal of Cardiology

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“…2,10 Corrective surgery is recommended for intramural segment cases. 3,11 An unroofing procedure is typically performed to correct the intramural segment. 2,3 Several repair procedures may be utilized depending on the nature of the patient's abnormality.…”

Section: Discussionmentioning

confidence: 99%

Needle in a Haystack

Fishe

2016

Clin Pediatr (Phila)

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“…They reported that the actuarial freedom from a coronary event of these patients for ten years would be 46%. Sachweh et al [11] reported that they found an intramural coronary artery in 5 patients (1.4%) of 351 who underwent ASO, and they transferred the intramural coronary artery as one button without unroofing the aortic wall. They also reported that, though there were neither operative mortality nor myocardiac ischemia, intramural coronary artery obstructions were identified by coronary angiograms that were performed at postoperative 5, 16, and 53 months later, and 2 of the patients had operations for a coronary artery bypass graft using an internal mammary artery.…”

Section: Discussionmentioning

confidence: 99%

Arterial Switch Operation in Patients with Intramural Coronary Artery: Early and Mid-term Results

Kim

Sung

Kim

et al. 2011

Korean J Thorac Cardiovasc Surg

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BackgroundThe intramural coronary artery has been known as a risk factor for early death after an arterial switch operation (ASO). We reviewed the morphological characteristics and evaluated the early and mid-term results of ASO for patients with an intramural coronary artery.Materials and MethodsFrom March 1994 to September 15th 2010, 158 patients underwent ASO at Dong-A and Pusan National University Hospitals for repair of transposition of the great arteries and double outlet right ventricle. Among these patients, 14 patients (8.9%) had an intramural coronary artery. Mean age at operation was 13.4±10.2 days (4 to 39 days) and mean body weight was 3.48±0.33 kg (2.88 to 3.88 kg). All patients except one were male. Eight patients had TGA/IVS and 4 patients had an aortic arch anomaly. Two patients (14.3%) had side-by-side great artery relation, of whom one had an intramural right coronary artery and the other had an intramural left anterior descending coronary artery. Twelve patients had anterior-posterior relation, all of whom had an intramural left coronary artery (LCA). The aortocoronary flap technique was used in coronary transfer in 8 patients, of whom one patient required a switch to the individual coronary button technique 2 days after operation because of myocardial ischemia. An individual coronary button implantation technique was adopted in 6, of whom 2 patients required left subclavian artery free graft to LCA during the same operation due to LCA injury during coronary button mobilization and LCA torsion.ResultsThere was 1 operative death (7.1%), which occurred in the first patient in our series. This patient underwent an aortocoronary flap procedure for coronary transfer combining aortic arch repair. Overall operative mortality for 144 patients without an intramural coronary artery was 13.2% (19/144). There was no statistical difference in operative mortality between the patients with and without an intramural coronary artery (p>0.1). There was no late death. The mean follow-up duration was 52.1±43.0 months (0.5 to 132 months). One patient who had a subclavian artery free graft required LCA stenting 6.5 years after surgery for LCA anastomotic site stenosis. No other surviving patient needed any intervention for coronary problems. All patients had normal ventricular function at latest echocardiography and were in NYHA class 1.ConclusionThe arterial switch operation in Transposition of Great Arteries or Double Outlet Right Ventricle patients with intramural coronary can be performed with low mortality; however, there is a high incidence of intraoperative or postoperative coronary problems, which can be managed with conversion to the individual coronary button technique and a bypass procedure using a left subclavian free graft. Both aortocoronary flap and individual coronary button implantation techniques for coronary transfer have excellent mid-term results.

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Fate of Intramural Coronary Arteries after Arterial Switch Operation

Cited by 15 publications

References 17 publications

Management of anomalous coronary arteries from the contralateral sinus

Management of anomalous coronary arteries from the contralateral sinus

Needle in a Haystack

Arterial Switch Operation in Patients with Intramural Coronary Artery: Early and Mid-term Results

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