Single coronary artery and complete transposition of the great arteries: a technical challenge resolved?

Shukla, Vinayak; Freedom, Robert M.; Black, Michael D.

doi:10.1016/s0003-4975(99)01324-7

Cited by 32 publications

(26 citation statements)

References 13 publications

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“…4 Although the concept of the repair of TGA has remained unchanged since Jatene, many surgeons have proposed different techniques in order to prevent the occurrence of coronary ischemia. 5,6 An ASO without coronary transfer has been proposed to deal with the single origin or intramural course of the coronary arteries 7 in order to reduce early mortality; however, the continued abnormal course of the coronary persists as a potential nidus for mortality as the patient matures. De Leval et al pointed out that the key point is to take the aorta away from the coronary arteries and pulmonary trunk is brought to them, rather than moving the coronary arteries from the aorta and transferring the coronary scallops to the pulmonary trunk or neo-aorta.…”

Section: Discussionmentioning

confidence: 99%

“…Shukla et al defended the technique of direct coronary button anastomosis to the previously anastomosed neo-aorta in cases with single coronary ostium. 6 In their technique, appropriate transection of the aorta and pulmonary artery has been shown to avoid the necessity of coronary button anastomosis to the neo-aortic suture line. In our study of 10 cases, the technique as described by Shukla et al 6 was used, in which neo-aortic anastomosis was made before the coronary button reconstructions.…”

Section: Discussionmentioning

confidence: 99%

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Arterial Switch Operations for Single Coronary Artery Ostium or Intramural Coronary Artery

Çetin¹,

Tirelı

Özkara³

et al. 2004

Circ J

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ecently, the arterial switch operation has become the first line surgical procedure for the correction of transposition of the great arteries (TGA) 1 and the determinants of success are the preoperative left ventricular performance, coronary artery anatomy and the experience of the surgical team. Complex coronary artery anatomy increases the operative risk. 1 Following repair of TGA with the usual coronary artery pattern in which the right and left coronary arteries arise from sinuses I and II respectively, kinking or tension of the coronary arteries is rarely seen; however, the risk increases in TGA with a single coronary ostium or intramural coronary artery patterns.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Arterial Switch Operations for Single Coronary Artery Ostium or Intramural Coronary Artery

Çetin¹,

Tirelı

Özkara³

et al. 2004

Circ J

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show abstract

“…Shukla et al reported no surgical mortalities in neonates with coronary arteries stemming from a single aortic sinus when a coronary button was translocated after the neoaortic anastomosis was performed. 39 Brown and colleagues also showed that the technique of completing the neoaortic anastomosis before selecting the ideal position for a mobilized coronary button signifi cantly decreased the incidence of unsuccessful coronary transfer. They found that the coronary artery pattern ceased to be an independent risk factor for surgical mortality after switching to this technique.…”

Section: Looping Course (Planché Group III /Yacoub Type D or E)mentioning

confidence: 99%

Modification of the arterial switch operation for transposition of the great arteries with complex coronary artery patterns

Suzuki

2009

Gen Thorac Cardiovasc Surg

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The arterial switch operation has evolved into the treatment of choice for most forms of transposition of the great arteries (TGA). Recently reported operative mortality of the procedure has fallen to the range of 1.1%-6.0%, even for complex forms of TGA. Despite advancement in the technical aspects of the procedure, certain anatomical variations of the coronary arteries, such as a single coronary orifice and/or intramural coronary artery, are still considered surgical risks in many centers. Optimizing the surgical technique for relocating these challenging variations of the coronary anatomy is key to improving the surgical outcomes for the procedure. In this review, the surgical modifications of the arterial switch operation for TGA associated with complex patterns of the coronary arteries are examined.

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“…Shukla, et al reported no surgical mortalities in neonates with coronary arteries stemming from a single aortic sinus when a coronary button was translocated after the neo-aortic anastomosis was performed. 14 Brown and colleagues also showed that the technique of completing the neo-aortic anastomosis before selecting the ideal position for a mobilized coronary button significantly decreased the incidence of unsuccessful coronary transfer. They found that coronary artery pattern ceased to be an independent risk factor for surgical mortality after switching to this technique.…”

Section: Discussionmentioning

confidence: 99%

Coronary Re-implantation after Completion of Neo-aortic Reconstruction in Arterial Switch Operation: Accurate Intraoperative Assessment for the Optimal Re-implantation Site

et al. 2009

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The arterial switch operation (ASO) has evolved into the treatment of the choice for most forms of transposition of the great arteries (TGA). Despite advancement in the technical aspects of the procedure, certain anatomical variations of the coronary arteries are still considered as surgical risks. We have recently employed a novel technique for coronary artery reconstruction in ASO to achieve further improvement of coronary transfer in cases with complex coronary anatomy. The technical key of the procedure is that reconstruction of the coronary arteries is preceded by neo-aortic anastomosis. After neo-aortic reconstruction is accomplished, the neo-aorta is temporarily distended with removal of the cross-clamp. The distended neo-aorta informs us its postsurgical geometry, which facilitates accurate assessment for the optimal site of coronary button transfer.

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Single coronary artery and complete transposition of the great arteries: a technical challenge resolved?

Cited by 32 publications

References 13 publications

Arterial Switch Operations for Single Coronary Artery Ostium or Intramural Coronary Artery

Arterial Switch Operations for Single Coronary Artery Ostium or Intramural Coronary Artery

Modification of the arterial switch operation for transposition of the great arteries with complex coronary artery patterns

Coronary Re-implantation after Completion of Neo-aortic Reconstruction in Arterial Switch Operation: Accurate Intraoperative Assessment for the Optimal Re-implantation Site

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