Percutaneous Coronary Intervention for Atherosclerotic Coronary Artery Disease After Arterial Switch Operation: A Case Report

Late coronary complications after an arterial switch operation (ASO) may occur due to vessel kinking, compression resulting from growth of the great vessels, ostial fibro-intimal thickening after reimplantation or possibly secondary to accelerated atherosclerosis. Given that many of these patients are asymptomatic, adult ASO survivors require special attention and an individualised approach to the early detection of coronary artery disease. Most previously reported cases of coronary artery disease after an ASO have been managed surgically. Owing to the complex anatomy of the aortic sinuses and abnormal coronary origin, percutaneous coronary intervention may be challenging with difficult catheter engagement and/or support. Pre-procedural multi-slice CT coronary angiography can be used for proper planning and guidance. A case is described here for percutaneous coronary intervention in an adult patient who presented with coronary artery disease 33 years after an ASO.