Coronary patterns with intramural arteries remain associated with high coronary mortality and morbidity following neonatal ASO, even in the current era. The association of slit-like deformation of the ostium, stenosis of the intramural course and abnormal angle of take-off might explain the difficulty in coronary transfer. The technique of coronary transfer should be individually adapted to each anatomical situation. The place of patch ostioplasty of the intramural artery remains to be determined.

The FRANCE-2 registry represents the largest database available on late results of TAVR. Late mortality is largely related to noncardiac causes. Incidence rates of severe events are low after the first month. Valve performance remains stable over time.

Anomalous aortic origin of coronary arteries (left coronary from right sinus or right coronary from left sinus) is a rare congenital defect, which carries a high risk of sudden cardiac death. The risk is particularly high when the interarterial course between the great arteries has an intramural segment, or is hypoplastic/stenotic, or has an abnormal orifice. Various surgical techniques have been used, including coronary artery bypass grafting, pulmonary artery translocation, partial or complete unroofing of the intramural course and patch enlargement of the interarterial course. We favour 'anatomical' repair that creates an enlarged neo-ostium into the appropriate sinus, eliminates completely the intramural segment and restores a normal angle of take-off. Reimplantation of the anomalous coronary artery may be indicated in variants without an intramural course. Surgical correction is mandatory for symptomatic and asymptomatic patients with evidence of myocardial ischaemia under stress; it is recommended in asymptomatic patients with high-risk variants (anomalous left coronary artery with the intramural course), particularly in young patients with strenuous activities.

In neonates with isolated ccTGA, prophylactic PA banding is safe and carries a low morbidity. At mid-term evaluation, tricuspid valve function is stabilised or improved and systemic competence of the left ventricle is maintained, thus allowing double switch if indicated.