Reoperation for coronary artery stenosis after arterial switch operation

Abstract

A standardized follow-up protocol including CT angiography or coronary angiography after the ASO is required to address coronary artery stenosis. Good reoperation results were observed using the unroofing and cut-back angioplasty techniques.

Risk Factors for Reoperation After Arterial Switch Operation

“…The incidence of coronary reinterventions is 1% to 6% in the literature. 12,19,20 In the current series, those with normal coronary arrangement had a 25-year cumulative incidence of coronary reintervention of less than 1% and anomalous coronary anatomy patients had a 25-year cumulative incidence of coronary reintervention of 8%. We attribute our low coronary reintervention rate to taking generous coronary buttons and positioning them in such a way as to limit unintended kinking or twisting.…”

Femoral artery homograft for coronary artery plasty following arterial switch operation

“…Coronary artery narrowing in the form of ostial stenosis or kinking is a well-recognized complication of ASO and presents in a bimodal pattern. 1,2 Risk factors for coronary artery stenosis following ASO include intramural coronary artery and single coronary artery, as highlighted previously. 3 In single coronary artery patterns, the coronary arteries arise from a common origin and extend in opposite directions, thereby increasing the likelihood of stretching or kinking of one or both of them following transfer during ASO.…”

“…4 Surgical ostial plasty usually involves extension of the aortotomy incision across the area of stenosis into the coronary artery and augmentation of the coronary artery using a patch. [1][2][3]5 Various types of patches have been described, including native and treated pericardium, bovine pericardium, and pulmonary homograft. Selection of the patch is crucial to avoid restenosis, as has been well described with the use of bovine pericardium.…”

“…Selection of the patch is crucial to avoid restenosis, as has been well described with the use of bovine pericardium. 2 In a redo situation, the pericardium and autologous tissues such as aorta and pulmonary artery can be sparse and fibrotic, making them less suitable for coronary artery plasty. Care must also be taken to avoid ballooning or kinking of the onlay patch, especially in the zone of bifurcation where the LMCA joins the right coronary artery and coronary opening in the aorta.…”

A rare case of congenital heart disease: anomalous origin of coronary artery from innominate artery with coronary fistula and truncus arteriosus

“…Moreover, no specific surgical technique has been used in cases with a high take-off coronary artery and frequently required reoperation due to coronary artery stenosis. 7 Although we performed preoperative cardiac catheterization for this patient, the anomalies of the coronary arteries were not found as coronary angiography was too dangerous to be performed on the infant. Not having CT angiography images for this special patient is a regret.…”