Related Experiment Videos
[Prevalence and diagnosis of coronary lesions after arterial switch]
A Legendre1, J Losay, A Touchot-Koné
1Centre Chirurgical Marie Lannelongue, 133, av. de la Résistance, 92350 Le Plessis Robinson. alegendre@ccml.com
Insights
Coronary artery complications after arterial switch surgery for transposition of the great arteries are common. Non-invasive tests lack sensitivity, making routine coronary angiography essential for early detection.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Diagnostic Imaging
Context:
- Transposition of the great arteries (TGA) repair involves arterial switch (AS) with critical coronary artery translocation.
- Coronary complications are the primary cause of mortality post-AS procedure.
- Assessing diagnostic methods for coronary lesions after AS is vital for patient outcomes.
Purpose:
- To determine the prevalence of coronary lesions following the arterial switch procedure.
- To evaluate the diagnostic accuracy of various non-invasive methods for detecting coronary lesions.
- To recommend optimal diagnostic strategies for post-AS patients.
Summary:
- A retrospective study analyzed 1,304 patients undergoing AS for TGA between 1982-2001.
- Coronary angiography in 324 patients revealed a 6.8% prevalence of coronary lesions.
- Type II coronary network (Marie Lannelongue Classification) was associated with a lower risk of lesions (OR=0.28).
- Non-invasive tests (ECG, echocardiography, stress testing, scintigraphy) showed low sensitivity (<50%) individually.
- Combined non-invasive methods achieved 75% sensitivity, but systematic coronary angiography and aortography are recommended.
Impact:
- Highlights the significant risk of coronary lesions after arterial switch surgery.
- Underscores the limitations of current non-invasive diagnostic tools for detecting these lesions.
- Recommends routine coronary angiography and aortography to improve surveillance and prevent mortality in TGA patients post-AS.
Abstract:
In anatomical repair procedure of transposition of the great arteries (arterial switch), translocation of the coronary arteries is crucial and coronary complications remain the principal cause of death. The aim of this retrospective study was to assess the prevalence of coronary lesions and to evaluate the diagnostic methods to prevent their consequences. From 1982 to 2001, 1,304 patients were operated for transposition of the great arteries by the switch procedure at the Marie Lannelongue Surgical Centre. The average follow-up of the survivors was 59 months (3 days to 17 years) during which 324 patients underwent coronary angiography. All had an ECG and an echocardiogram (N = 324); 174 underwent exercise stress testing and 115 had myocardial scintigraphy. Of the 324 patients who underwent coronary angiography, 22 had coronary lesions (6.8%; 95% CI 5-10). In multivariate analysis a type II coronary network by the Marie Lannelongue Classification was related to the risk of coronary lesions (OR = 0.28; p < 0.0002). Each non-invasive method studied separately had a low sensitivity (< 50%) for the detection of these lesions. The association of ECG, echocardiography and myocardial scintigraphy had the best sensitivity at 75%. Therefore, after the arterial switch procedure non-invasive investigations are not sensitive enough to diagnose coronary lesions and systematic coronary angiography and aortography should be performed in all patients.