PO-0049Coronary Artery Anomalies In Patients Undergoing Arterial Switch Operation

Background and aimsThe arterial switch operation (ASO) is the surgical standard of care for repair of transposition of the great arteries (D-TGA). Until recently, anatomical variations of the coronary arteries, especially the intramural course of a single coronary artery, were considered contraindications for ASO. Transfer of the coronary arteries may be a surgical challenge in these cases increasing the risk of (sub-)acute coronary artery occlusions.MethodsWe report our management of two exemplary cases of D-TGA with coronary artery anomalies:(1) Single coronary ostium of RCA, Cx and LAD originating from aortic sinus II and an intramural course of the proximal LAD.(2) Side-by-side position of the great arteries, RCA and LAD originating from sinus I and Cx from sinus II.ResultsBoth neonates successfully underwent ASO with transfer of the coronary arteries.During the post-operative period, patient 1 was diagnosed with a subacute anteroseptal ischemia and was then managed conservatively. Follow-up echocardiogram at 12 months demonstrated satisfactory left and good right ventricular function.The postsurgical course of patient 2 was uneventful with good biventricular function at follow-up.ConclusionsAnatomical variations of the coronary arteries require adaptions of the surgical technique of coronary artery transfer. Nowadays, ASO is even possible in patients with D-TGA and complex coronary anomalies. The long-term management, however, has to be evaluated, e.g. regarding the need for coronary artery re-surgery.