Variation in Coronary Anatomy in Adult Patients Late After Arterial Switch Operation: A Computed Tomography Coronary Angiography Study

Veltman, Caroline E.; Beeres, Saskia L.M.A.; Kalkman, Deborah N.; Kelder, Tim P.; Kiès, Philippine; Vliegen, Hubert W.; Hazekamp, Mark G.; Delgado, Victoria; Kroft, Lucia J.M.; Wall, Ernst E. van der; Groot, Adriana C. Gittenberger‐de; Scholte, Arthur J.; Schalij, Martin J.; Jongbloed, Monique R.M.

doi:10.1016/j.athoracsur.2013.05.004

Cited by 20 publications

(18 citation statements)

References 22 publications

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“…Acute angle of the coronary origin has been observed frequently with neoaortic root dilatation, 28 particularly in adults late after ASO. 29 The underlying mechanisms of coronary artery obstruction after ASO are multifold.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Problems Late After Arterial Switch Operation for Transposition of the Great Arteries

Tsuda

Bhat

Robinson

et al. 2015

Circ J

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Background:The incidence of late coronary artery abnormalities after arterial switch operation (ASO) for d-loop transposition of the great arteries may be underestimated. Methods and Results:We retrospectively reviewed coronary artery morphology in 40 of 97 patients who survived the first year after ASO. Seven asymptomatic patients developed significant late coronary artery abnormalities. One patient died suddenly at home with severe left coronary artery (LCA) ostial stenosis at age 3.8 years. The second patient collapsed during exercise at age 9.6 years due to ventricular fibrillation and severe LCA ostial stenosis despite prior negative exercise stress test (EST) and myocardial perfusion imaging (MPI). The third patient was found to have moderate ostial stenosis of the LCA with negative EST and MPI. The fourth patient with exercise-induced ST-T depression and myocardial perfusion defect was shown to have complete LCA occlusion with collateral vessel formation. Three other patients had complete proximal obliteration of either of the coronary arteries with collateral supply. An additional 4 asymptomatic patients had trivial-mild narrowing of the LCA on routine selective coronary angiogram. Conclusions:Incidence of late coronary stenosis or occlusion was not infrequent after ASO (11.3%) and presented usually without preceding symptoms and often after negative non-invasive screening. We advocate routine coronary imaging in all patients after ASO before they participate in competitive sports. 2373 Late Coronary Problems After ASO Laboratory). MPI was performed with technetium-99 m sestamibi injection, and perfusion imaging was obtained before and after exercise. Studies were read by a radiologist specialized in nuclear medicine. All cardiac catheterizations and angiograms were reviewed by W.R., Director of the Cardiac Catheterization Laboratory. All study results and original images were presented and carefully discussed in a weekly Multidisciplinary Case Conference at Nemours Cardiac Center for final consensus among the group, which included all attending cardiologists, intensivists, surgeons, and anesthesiologists prior to any critical decisions being made.

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Section: Discussionmentioning

confidence: 99%

Coronary Artery Problems Late After Arterial Switch Operation for Transposition of the Great Arteries

Tsuda

Bhat

Robinson

et al. 2015

Circ J

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“…Firstly, sub-optimal coronary perfusion could lead to chronic ischemia inducing left ventricular (LV) damage and remodeling. The coronary arteries are reimplanted in a non-physiologic, sub-optimal position in the coronary sinuses, but higher in the aortic root and at a more acute angle [5]. Doubts exist whether coronary function (coronary flow reserve) is affected by this abnormal anatomy [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Left Ventricular Function Long Term After Arterial Switch Operation for Transposition of the Great Arteries

et al. 2018

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Long-term after arterial switch operation for transposition of the great arteries, abnormal coronary anatomy and altered loading conditions could compromise ventricular function. The current study investigates whether left ventricular function, measured with echocardiographic bi-plane ejection fraction and deformation imaging, in patients long term after arterial switch operation for transposition of the great arteries differs from healthy peers. A cross-sectional cohort study of patients at least 12 years after arterial switch operation was analyzed with bi-plane Simpson's left ventricular ejection fraction (LVEF) and deformation (speckle tracking) echocardiography. 81 patients, median age 20.6 (interquartile range 13.5-28.4) years, were included. LVEF was normal on average at 55.5 ± 6.1%. Global longitudinal strain (GLS) was lower in patients compared to healthy peers throughout all age groups and on pooled average (- 15.4 ± 1.1% vs. - 23.2 ± 0.9%). Although LVEF is normal on average in patients after arterial switch operation for transposition of the great arteries, GLS is impaired compared to healthy peers. The reduced GLS could indicate sub-clinical myocardial dysfunction.

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“…In patients with HLHS, the arterial duct is the main source of systemic blood flow and provides retrograde filling to the coronary arteries 33. High take-off coronary arteries have been associated with acute angulation,16 potentially forming an impediment to this retrograde coronary flow. Whether this is a mechanism contributing to fetal demise in cases with HLV and the consequences after Norwood procedures is as yet unknown.…”

Section: Discussionmentioning

confidence: 99%

“…When unrecognised, there have been cases of inadvertent transection and coronary cross-clamping during open-heart procedures 14 15. High take-off coronaries have also been associated with intramural coronary course11 and may impair coronary blood flow due to formation of an acute angle with the ostial ridge and angulation may increase with increasing aortic dimensions 16…”

Section: Introductionmentioning

confidence: 99%

Coronary anatomy in children with bicuspid aortic valves and associated congenital heart disease

Koenraadt

Bartelings

Bökenkamp

et al. 2017

Heart

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High take-off coronary arteries, especially the LCA, occur more frequently in BAV with associated CHD than reported in normal hearts and isolated BAV. Outflow tract defects and HLV are associated with type 1A BAV and high take-off coronary arteries. Although it is unclear whether these findings in infants with detrimental outcome can be related to surviving adults, clinical awareness of variations in coronary anatomy is warranted.

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Variation in Coronary Anatomy in Adult Patients Late After Arterial Switch Operation: A Computed Tomography Coronary Angiography Study

Cited by 20 publications

References 22 publications

Coronary Artery Problems Late After Arterial Switch Operation for Transposition of the Great Arteries

Coronary Artery Problems Late After Arterial Switch Operation for Transposition of the Great Arteries

Evaluation of Left Ventricular Function Long Term After Arterial Switch Operation for Transposition of the Great Arteries

Coronary anatomy in children with bicuspid aortic valves and associated congenital heart disease

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