Vertically oriented intramural right coronary artery in complete transposition of the great arteries: prospective...

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Congenital Heart Disease

Background:

• Complete transposition of the great arteries (TGA) is a critical congenital heart defect requiring surgical correction.
• Anomalous coronary artery origins can complicate TGA repair, posing risks to myocardial perfusion.

Observation:

• A rare case of TGA presented with an intramural right coronary artery (RCA) originating above the sinotubular junction.
• The left circumflex artery anomalously originated as a branch of the right coronary artery.

Findings:

• Transthoracic echocardiography accurately identified the complex coronary anomaly preoperatively.
• The arterial switch operation was successfully performed on day 6 of life.
• The surgical technique for coronary transfer was modified to preserve the intramural RCA.

Implications:

• Preoperative diagnosis of coronary anomalies is crucial for tailoring surgical strategies in TGA.
• Modified coronary transfer techniques can ensure myocardial protection in complex cases.
• This case highlights the importance of detailed echocardiographic assessment in neonates with TGA.