Unroofing intramural coronary artery for late coronary events after arterial switch operation

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Interventional Cardiology

Background:

• Intramural coronary arteries (IMCA) are uncommon in patients with transposition of the great arteries (TGA).
• IMCA are linked to significant risks of coronary adverse events, both early and late.
• Understanding the behavior of IMCA in TGA is crucial for patient management.

Observation:

• A patient with TGA experienced late coronary adverse events.
• The cause was identified as an intramural left coronary artery.
• This anatomical variation presented a diagnostic and therapeutic challenge.

Findings:

• The intramural left coronary artery in this TGA patient led to significant late coronary events.
• Surgical unroofing of the intramural coronary artery was performed.
• The unroofing procedure effectively resolved the adverse coronary events.

Implications:

• The unroofing procedure is a viable treatment for late coronary events caused by IMCA in TGA.
• Early identification and intervention for IMCA in TGA patients are essential.
• This case expands the understanding of IMCA management in complex congenital heart disease.