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Can we predict potentially dangerous coronary patterns in patients with transposition of the great arteries after an arterial switch operation?

Published online by Cambridge University Press:  11 September 2019

Krzysztof W. Michalak Open the ORCID record for Krzysztof W. Michalak [Opens in a new window] ,
Katarzyna Sobczak-Budlewska ,
Jacek J. Moll ,
Konrad Szymczyk ,
Jadwiga A. Moll ,
Marek Niwald ,
Paweł Dryżek  and
Maciej Moll
Krzysztof W. Michalak*
Affiliation:
Department of Cardiology, Polish Mother’s Memorial Hospital, Lodz, Poland
Katarzyna Sobczak-Budlewska
Affiliation:
Department of Cardiology, Polish Mother’s Memorial Hospital, Lodz, Poland
Jacek J. Moll
Affiliation:
Department of Cardiac Surgery, Polish Mother’s Memorial Hospital, Lodz, Poland
Konrad Szymczyk
Affiliation:
Department of Diagnostic Imaging, Polish Mother’s Memorial Hospital, Lodz, Poland
Jadwiga A. Moll
Affiliation:
Department of Cardiology, Polish Mother’s Memorial Hospital, Lodz, Poland
Marek Niwald
Affiliation:
Department of Cardiology, Polish Mother’s Memorial Hospital, Lodz, Poland
Paweł Dryżek
Affiliation:
Department of Cardiology, Polish Mother’s Memorial Hospital, Lodz, Poland
Maciej Moll
Affiliation:
Department of Cardiac Surgery, Polish Mother’s Memorial Hospital, Lodz, Poland
*
Author for correspondence: K. W. Michalak, MD, PhD, Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, 93-338 Lodz, ul. Rzgowska 281/289, Lodz, Poland. Tel: 00-48-42-271-14-78; Fax: 00-48-42-271-14-70; E-mail: krzysztof.michalak@iczmp.edu.pl
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Abstract

Introduction:

Coronary artery complications are the main reason for early mortality after an arterial switch operation. Late complications are relatively rare, and there is no consensus regarding the need or indications for routine follow-up coronary artery evaluations or the best first-line assessment modality. The aim of this study was to present the long-term post-operative frequency of coronary abnormalities in asymptomatic patients with transposition of the great arteries discovered by coronary CT angiography and potential “red flags” revealed by other examinations.

Patients and methods:

A group of 50 consecutive asymptomatic patients who underwent routine long-term coronary artery evaluation after an arterial switch operation according to our institutional protocol were qualified for this study. This routine in-hospital visit included a detailed medical interview, electrocardiography, echocardiography, Holter electrocardiography examinations, and laboratory and cardiopulmonary exercise tests. Patients who showed significant abnormalities were qualified for perfusion scintigraphy.

Results:

Unfavourable coronary abnormalities were detected in 30 patients (60%) and included ostial stenosis, muscular bridge, coronary fistula, interarterial course, proximal kinking, high ellipticity index, proximal acute angulation (<30 degree) of the left coronary artery, and proximal acute angulation of the right coronary artery. These features could not be predicted based on the medical interviews, surgical reports, or non-invasive screening test results.

Conclusion:

Complex coronary configurations with potentially dangerous coronary features are common in patients with transposition after an arterial switch operation. Such high-risk patients cannot be identified indirectly, and coronary CT angiography provides accurate information that is useful for post-operative management.

Keywords

Transposition of the great arteriesarterial switch operationcoronary anomaliescoronary complications
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 11 , November 2019 , pp. 1350 - 1355
Copyright
© Cambridge University Press 2019 

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