Arterial switch operation for transposition of the great arteries with anomalies of cardiac situs and aortic position (original) (raw)
Related papers
Coronary artery anatomy in complete transposition of the great arteries with situs inversus
The American Journal of Cardiology, 2002
The coronary artery anatomy of complete transposition with situs solitus/levocardia (CTSSL) has been well elucidated in the current era of arterial switch operation. However, coronary artery for complete transposition with situs solitus/dextrocardia (CTSSD) has never been documented. Coronary anatomy of transposition and aortopulmonary rotation were identified by angiography or surgical intervention from 1988 to 2007 at our hospital. The degree of aortopulmonary rotation was defined by the aortic sinus pattern on lateral angiogram. Apicocaval ipsilaterality was defined as situs solitus/dextrocardia or situs inversus/levocardia. The coronary artery anatomy in 3 cases of CTSSD was analyzed and correlated with those patients having transposition with the same coronary pattern but without apicocaval ipsilaterality, i.e., 276 cases with CTSSL and 8 cases with complete transposition with situs inversus/dextrocardia (CTSID). Fisher's exact test was used to determine statistical significance. All three cases with CTSSD (with apicocaval ipsilaterality) had a single coronary artery piercing into the left-hand sinus with a right coronary artery in the posterior atrioventricular groove, whereas all 284 cases without apicocaval ipsilaterality (CTSSL or CTSID) had the left circumflex artery in the posterior atrioventricular groove. The aorta was significantly less left laterally rotated in CTSSD than the other 2 cases of CTSSL and 3 cases of CTSSD with a similar coronary pattern (p \ 0.05). One may anticipate coronary artery anatomy in the posterior atrioventricular groove based on apicocaval ipsilaterality, which in turn decreases aortopulmonary rotation to predict the central coronary pattern.
Coronary artery anatomy in complete transposition of the great arteries
Annals of Thoracic Surgery, 1994
The coronary artery anatomy of complete transposition with situs solitus/levocardia (CTSSL) has been well elucidated in the current era of arterial switch operation. However, coronary artery for complete transposition with situs solitus/dextrocardia (CTSSD) has never been documented. Coronary anatomy of transposition and aortopulmonary rotation were identified by angiography or surgical intervention from 1988 to 2007 at our hospital. The degree of aortopulmonary rotation was defined by the aortic sinus pattern on lateral angiogram. Apicocaval ipsilaterality was defined as situs solitus/dextrocardia or situs inversus/levocardia. The coronary artery anatomy in 3 cases of CTSSD was analyzed and correlated with those patients having transposition with the same coronary pattern but without apicocaval ipsilaterality, i.e., 276 cases with CTSSL and 8 cases with complete transposition with situs inversus/dextrocardia (CTSID). Fisher's exact test was used to determine statistical significance. All three cases with CTSSD (with apicocaval ipsilaterality) had a single coronary artery piercing into the left-hand sinus with a right coronary artery in the posterior atrioventricular groove, whereas all 284 cases without apicocaval ipsilaterality (CTSSL or CTSID) had the left circumflex artery in the posterior atrioventricular groove. The aorta was significantly less left laterally rotated in CTSSD than the other 2 cases of CTSSL and 3 cases of CTSSD with a similar coronary pattern (p \ 0.05). One may anticipate coronary artery anatomy in the posterior atrioventricular groove based on apicocaval ipsilaterality, which in turn decreases aortopulmonary rotation to predict the central coronary pattern.
Brazilian Journal of Cardiovascular Surgery, 2016
Objective: Transposition of the great arteries is a common congenital heart disease. Arterial switch is the gold standard operation for this complex heart disease. Arterial switch operation in the presence of intramural coronary artery is surgically the most demanding even for the most experienced hands. We are presenting our experience with a modified technique for intramural coronary arteries in arterial switch operation. Methods: This prospective study involves 450 patients undergoing arterial switch operation at our institute from April 2006 to December 2013 (7.6 years). Eighteen patients underwent arterial switch operation with intramural coronary artery. The coronary patterns and technique used are detailed in the text. Results: The overall mortality found in the subgroup of 18 patients having intramural coronary artery was 16% (n=3). Our first patient had an accidental injury to the left coronary artery and died in the operating room. A seven-day old newborn died from intractable ventricular arrhythmia fifteen hours after surgery. Another patient who had multiple ventricular septal defects with type B arch interruption died from residual apical ventricular septal defect and sepsis on the eleventh postoperative day. The remainder of the patients are doing well, showing a median follow-up duration of 1235.34±815.26 days (range 369-2730). Conclusion: Transposition of the great arteries with intramural coronary artery is demanding in a subset of patients undergoing arterial switch operation. We believe our technique of coronary button dissection in the presence of intramural coronary arteries using coronary shunt is simple and can be a good addition to the surgeons' armamentarium.
Two-Stage Correction of Transposition of Great Arteries With Complete Atrioventricular Canal
The Annals of Thoracic Surgery, 1998
exercise, may recreate in essence the lethal situation described above by directing the left main coronary artery anterior to the pulmonary artery. This potentially lethal situation holds especially true when the coronary artery to be translocated arises from the left-facing pulmonary valve sinus and thus is limited to translocation into the proximal anterior aorta .
The Journal of Thoracic and Cardiovascular Surgery, 2013
Background: The arterial switch operation (ASO) for transposition of the great arteries requires transfer of the coronary arteries from the aorta to the proximal pulmonary artery (neoaorta). This is complicated by variable coronary anatomy before transfer. In 8% to 10% of cases, there is evidence of late coronary stenosis and/or occlusion, often with catastrophic clinical consequences. The mechanism of such complications has not been well studied. Methods and Results: We analyzed 190 consecutive high-resolution computed tomographic scans from the ASO procedure (patients aged 5-16 years) and found 17 patients with significant (>30% up to occlusion) coronary lesions (8.9%); all were later confirmed by conventional angiography. The left main coronary artery was abnormal in 9 patients (ostium in all), the left anterior descending artery in 3, the circumflex in 2, and the right coronary artery in 3 patients. Using multiplanar and 3-dimensional reconstructions of the coronary arteries, aorta, and pulmonary artery, we identified the commonest mechanisms of coronary abnormalities. For the left main and left anterior descending artery, anterior positioning of the transferred left coronary artery (between 12 and 1 o'clock on the neoaorta) appeared to predispose to a tangential course of the proximal left coronary artery promoting stenosis. All circumflex lesions occurred in Yacoub type D coronaries where a long initially retroaortic artery was stretched by its new positioning behind an enlarged neoaorta. Right coronary artery lesions occurred only in cases in which the reimplantation site was very high above the right coronary sinus with potential compression from the main pulmonary artery bifurcation immediately above. Conclusions: Thus detailed multiplanar computed tomographic scanning can elucidate the mechanisms of late coronary complications after the ASO. Understanding these aspects could help to improve surgical technique to minimize the risk of late coronary obstructions.
The American Journal of Cardiology, 1995
Because the arterial switch operation has become the routine surgical approach for transposition of the great arteries, there is increasing awareness of adverse sequelae in some survivors. For the arterial switch to be considered the procedure of choice for transposition of the great arteries, long-term patency and normal function of the translocated coronary arteries must be achieved. We reviewed the cineangiograms and hemodynamic data in 366 patients who underwent postoperative catheterization after arterial switch operation. Of these, 13 patients (3%) had previously unsuspected coronary abnormalities diagnosed angiographicall . No tient had noninvasive evidence of resting systo ic dys/ktion. F' d r m ings included left main coronary a T stenosis (n = 3) or occlusion (n = 4, anterior descening coronary artery stenosis (n = 1) or occlusion (n = 2), right corona 7 artery stenosis (n = 1) or occlusion (n = l), and sma I coronary artery fistulas (n = 3). One patient died suddenly 3.3 years after surgery, 1 patient is lost to follow-up, and the remaining 10 patients are alive and asymptomatic up to 11 ears after surgery. (Am J Cardiolyl 995;76: 153-l 57)
Complete transposition of the great arteries and coarctation of the aorta
The American Journal of Cardiology, 1984
Thirty-two patients with complete transposition of the great arteries (TGA) and coarctation of the aorta (C of A) were seen at The Hospital for Sick Children, Toronto, Canada, between 1963 and 1963. Three patients had only mild C of A and have not required coarctectomy (Group I); 29 had a severe form of C of A (Group II). Two patients in Group I and 21 in Group II had a ventricular septal defect. Subaortic obstruction was present in 5 patients in Group II. The mechanisms included anterior deviation of the infundibular ventricular septum, anomalous right ventricular muscle bundles, and abnormal ventric-uloinfundibular fold. Five patients in Group II had a hypoplastic right ventricle. Coarctectomy was performed in 25 patients, and 5 dii (20% mortaltty rate). Sixteen patients had repair for TGA (13 Mustard, 2 Jatene, 1 Rastelli), and 2 died (12% mortality rate). Life-table analysis shows that only 66 % of the patients with TGA and C of A survived the first month of life. The 5-year survival in this group was 57 %. In the same period, 94 % of patients with uncomplicated TGA survived the first month of life and the S-year survival rate was 89%. (Am J Cardiol 1984;53:1627-1632) Obstructive anomalies of the aortic arch tend to reflect the severity of those intracardiac disturbances that favor pulmonary blood flow at the expense of aortic blood flow.'m3 Many reports have been devoted to the anatomy and surgical implications of the abnormal left ventricular outflow tract in patients with obstructive anomalies of the aortic arch and concordant atrioventricular (AV) and ventriculoarterial connections.1,3-8 Less information is available about the right ventricle and its outflow tract in patients with coarctation of the aorta (C! of A) and complete transposition of the great arteries (TGA).gm*l This report focuses on the morphologic features of the right ventricle in 32 patients with combined complete TGA and C of A.
Coronary Artery Anomalies in D-Transposition of the Great Artery Following Arterial Switch Operation
Congenital Heart Disease
Background: The survival rate of patients following arterial switch operation (ASO) exceeds 95%, but coronary artery anomalies (CAA) contribute to a 2% incidence of sudden cardiac arrest later in life. Therefore, we aimed to assess abnormal findings of coronary arteries in post-ASO patients. Methods: Coronary computed tomography angiography (CCTA) is performed on post-ASO patients who meet institutional criteria. Intraoperative findings of coronary artery patterns were retrospectively reviewed and categorized using the Leiden classification system. Coronary artery anomalies were detected by CCTA and associations with coronary artery compromise were explored. Results: Forty-three patients who had CCTA with a median age of 15.6 years (12-21.3 years) were included in the study. Unusual coronary patterns were identified in 20 (46%) patients before ASO. CCTA identified 25 CAA in 22 patients (eleven with prepulmonic course, nine with interarterial course, three with acute takeoff angle, and two with significant stenosis). Postoperative CAA was more common in patients with unusual coronary patterns (90% vs. 17.4%; p < 0.001). Nine patients experienced chest pain and two patients required coronary artery bypass graft. A common ostium of RCA and LAD or LMCA were associated with significant chest pain (OR 14.3%, 95% CI 2.5 to 82.3). Conclusions: Coronary artery anomalies in post-ASO are common. All post-ASO patients should have coronary artery imaging before participating in competitive sport and when they reach adolescence. Patients with unusual preoperative coronary artery patterns should undergo coronary artery imaging when feasible. Follow-up imaging studies are indicated in patients with post-operative coronary artery abnormalities. KEYWORDS Coronary artery anomalies; arterial switch operation; d-transposition of great arteries Abbreviations Ao aorta AOR adjusted odds ratio ASO arterial switch operation AR aortic regurgitation BMP beat per minute CAA coronary artery anomalies This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The American Journal of Cardiology, 1971
Three hearts studied at autopsy with transposition of the great arteries and posterior aorta with isolated or predominantly subaortic conus are described. In all cases the aorta was posterior and to the right of the pulmonary trunk. In two cases it was significantly distant from the puhnonary trunk and in one it was very close. The caliber of the pulmonary trunk was huger than that of the aorta: > 2: 1 in two cases and-C 2: 1 in one case. A well developed subaortic conus was seen in ail cases and a small subpulmonary conus in one case. In the other two cases, the pulmonary valve was in fibrous continuity with the mitral valve. In all cases the aortic valve was higher than the pulmonary valve, the relative heights above the ventricles being 25/20, 25/30 and 40/60 mm, respectively. The left coronary artery ran posteriorly and to the left of the puhnonary trunk in all the cases. The length of the main stem of the left coronary artery was 11, 11 and 30 mm, respectively. We discuss the signifiie of this type of transposition of the great arteries for techniques currently used for surgical correction. Transposition of the great arteries with a posterior aorta was discussed in depth for the first time in 1971 by Van Praagh et al. [l], although one of the cases described had already been published in 1969 by Quero-Jimenez et al. [2]. Afterwards, several papers were devoted to this particular variant of transposed great arteries [3-71. In all these accounts [1,3-71 the posterior aortic valve has been in
Coronary arteries in transposition of the great arteries
The American Journal of Cardiology, 1994
The topic of coronary arteries in transposition of the great arteries (TGA) is complex and confusing despite having been the subject of several recently published reports. One hundred thirtythree autopsy specimens of uncomplicated TGA were studied, with special attention to method-olog~c issues in anatomic description and classification. lJncomplicated TGA was defined as congenital anomaly involving origin of the aorta from the right ventricle and of the pulmonary artery from the left ventricle. Three types of transposition were recognized ("anterior aorta," "side-by-side," and "posterior aorta") depending on the aortopulmonary relations, which were intrinsically defined by the relation of the valvular orifices of the great arteries with respect to the atrioventricular orifices. The frequency of distribution of individual coronary patterns differs substantially in the first 2 types of TGA. As in normal hearts, coronary arteries in TGA tend to originate from the facing sinuses (adjacent to the pulmonary valve); in TGA, however, variations in further distal anatomy are much more frequent. It is suggested that individual coronary patterns be described in terms of number of ostia, exact ostial location within or outside the aotiic sinuses, and proximal course and distribution. The use of strict, simplified classifications of coronary patterns is discouraging because of the relevance of each individual anatomic parameter to clinical aims. Because of the aortopulmonary switch repair for TGA, this study emphasizes the surgical implications of the different coronary features.