Results of arterial switch operation in patients with intramural coronary artery

Objective To evaluated the early and mid-term results of arterial switch operation (ASO) for patients with intramural coronary artery.Methods From September 2008 to March 2012,75 patients underwent ASO at Guangzhou Women and Children Medical Center for repair of transposition of the great arteries and Taussig-Bing anomaly.Among these patients,7patients (9.3％) had an intramural coronary artery.Mean age at operation was 2.4 months (2 days to 1 year) and mean body weight was(4.3 ±2.2) kg.The TGA and VSD in 3 cases,TGA/IVS in 2,and Taussig-Bing anomaly in 2.Among them 3 patients had an aortic arch anomaly,interruption of the aortic arch in 1 and coarctation of the aorta in 1.The individual coronary button technique was used in coronary transfer in 7 patients,of whom one patient required to unroof the intramural segment,an-other one required to unroof the intramural segment and enlarge with autologous pericardium the because of myocardial ischemia.There was 1 operative death because of low cardiac output syndrome.This patient underwent a coronary transfer combining aortic arch repair but without unroofing the stenotic intramural segment.The mortality was 14.2％.In the same period the mortality for 68 patients without an intramural coronary artery was 4.4％ (3/68).There was no statistical difference in mortalitv between the patients with and without an intramural coronary artery (P ＞ 0.05).Results 6 patients follow-up 4 to 47months.There was no late death.No intramural coronary artery obstruction was identified by cardiac computerize temography.All patients had normal ventricular function and were in NYHA class Ⅰ during follow-up.The intramural coronary artery is well known as a risk factor of ASO.Conclusion The technique of coronary transfer should be individually adapted to each anatomical situation.Individual technique for coronary transfer has excellent results.