Excellent Long-Term Outcomes of the Arterial Switch Operation in Patients With Intramural Coronary Arteries Tyson A. Fricke, MBBS, BMedSci, Anne Eva.

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Presentation transcript:

Excellent Long-Term Outcomes of the Arterial Switch Operation in Patients With Intramural Coronary Arteries Tyson A. Fricke, MBBS, BMedSci, Anne Eva Bulstra, BS, Phillip S. Naimo, MD, Andrew Bullock, MBBS, Terry Robertson, MBBS, Yves d’Udekem, MD, PhD, Christian P. Brizard, MD, Igor E. Konstantinov, MD, PhD The Annals of Thoracic Surgery Volume 101, Issue 2, Pages 725-729 (February 2016) DOI: 10.1016/j.athoracsur.2015.08.090 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A–F) Intramural course of the left coronary artery (LCA) was most common (n = 27) and in most patients (n = 17) the intramural LCA came from sinus 2 (A and D). Intramural right coronary artery (RCA) was encountered in 2 children (E and G). (Ao = aorta; LAD = left anterior descending coronary artery; LCx = left circumflex coronary artery; PA = pulmonary artery.) The Annals of Thoracic Surgery 2016 101, 725-729DOI: (10.1016/j.athoracsur.2015.08.090) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Surgical technique of intramural coronary artery transfer. Following identification of (A) the intramural segment, the detachment of the posterior commissure of (B) the aortic (neopulmonary) valve was performed in most patients (n = 25). The unroofing of the (C) intramural coronary artery was done in 16 patients. Then the coronary arteries were detached and transferred either as (D) a single button facilitated with a pericardial hood (D1–D3) in the first 3 patients or as (E) two separate buttons using the trapdoor technique (E1–E2) in the next 25 consecutive patients. In all patients the pulmonary artery was reconstructed with a single autologous pericardial patch and the posterior neopulmonary valve commissure was reattached to it. (Ao = aorta; LAD = left anterior descending coronary artery; LCx = left circumflex coronary artery; RCA = right coronary artery.) The Annals of Thoracic Surgery 2016 101, 725-729DOI: (10.1016/j.athoracsur.2015.08.090) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Freedom from reoperation. The Annals of Thoracic Surgery 2016 101, 725-729DOI: (10.1016/j.athoracsur.2015.08.090) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions