Arterial Switch Operation with Coronary Arteries from a Single Sinus in Infants

Background: The implantation of a coronary artery (CA) is critical for the arterial switch operation (ASO) done to treat complete transposition of the great arteries (TGA). Coronary artery abnormalities are risk factors for both early and late mortality after surgery. In this study, the methodology and effects of ASO surgery with coronary arteries from a single sinus were evaluated. Methods and Results: From March 1999 to June 2006, 31 patients were treated with ASO with coronary arteries from a single sinus in our hospital. They aged 11 hours ˜ 16 months (2.8 ± 3.9 months) and weighted 2.3 ˜7.8Kg (3.1 ± 2.5Kg). 27 cases had TGA and a ventricular septal defect (VSD), and 4 had TGA and an intact ventricular septum (IVS). During surgery, a CA button was implanted in the new proximal aorta with “trapdoor” technique or by inverting 90 degrees dorsally; pericardium or arterial augmentation was implanted at the base of the new major artery. The mortality rate after surgery was 25.8%. After 2-5 years of follow-up, 2 cases with residual shunting recovered spontaneously, 2 cases had residual pulmonary artery obstruction (30-56 mmHg), and none of the patients had any significant changes in myocardial ischemia. Conclusion: The implantation of an abnormal coronary artery is practical and feasible; it can reduce both the occurrence of twisting and deforming in the coronary artery after implantation, as well as myocardial ischemia after surgery. Thus, this could improve the surgical success and cure rates.