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Single coronary artery and complete transposition of the great arteries: a technical challenge resolved?
V Shukla1, R M Freedom, M D Black
1Division of Cardiovascular Surgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada.
Insights
A rare congenital anomaly, single coronary artery origin, poses surgical challenges. A prophylactic technique for D-transposition of the great arteries (D-TGA) significantly reduced surgical mortality to 0% in recent cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Single coronary artery origin is a rare congenital anomaly.
- Historically considered of minor clinical importance.
- Increasingly significant due to complex surgical repair needs.
Purpose of the Study:
- To highlight a prophylactic surgical technique for D-transposition of the great arteries (D-TGA) with single coronary artery.
- To demonstrate the efficacy of this technique in complex congenital heart repairs.
Main Methods:
- Review of an institutional cardiac registry.
- Analysis of surgical outcomes for neonates with D-TGA and single coronary artery.
Main Results:
- Historical mortality rates for D-TGA/single coronary artery repair were high (38-41%).
- A specific prophylactic technique was applied to 6 neonates with D-TGA/single coronary artery in the last 3.5 years.
- Surgical mortality dropped to 0% with this technique.
Conclusions:
- Surgical repair of D-TGA with single coronary artery remains challenging.
- A key prophylactic technique involves implanting a well-mobilized coronary button into the neoaorta.
- This technique achieves favorable technical results and improves patient outcomes.
Background:
The origin of the coronary arteries from a single aortic sinus remains a rare congenital anomaly, once regarded as having little clinical significance. Contemporary surgical practice, however, frequently demands precise coronary reimplantation. In this article we emphasize a prophylactic surgical technique found especially helpful in the repair of D-transposition of the great arteries (D-TGA)/single coronary artery.
Methods:
We reviewed the institutional cardiac registry.
Results:
Since 1985, 398 neonates with D-TGA were repaired with the arterial switch procedure. A mortality rate of 38% was encountered in "simple" D-TGA (n = 174)/single coronary (2.9% left facing sinus (IRLCx), 7.5% right facing sinus (IIRLCx)) and 41% in neonates with D-TGA (n = 224)/single coronary (3.6% IRLCx, 12% IIRLCx). During the past 3.5 years the surgical mortality rate of neonates (n = 6) treated with origin of the coronary arteries from a single aortic sinus has dropped to 0%.
Conclusions:
The surgical repair of D-TGA/single coronary artery continues to trouble surgeons. The implantation of a well-mobilized coronary "button" into a previously anastomosed neoaorta remains a key prophylactic technique in the achievement of good technical results.
