Left main coronary artery occlusion in an asymptomatic patient: late complication after arterial switch operation

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• The arterial switch operation (ASO) is a standard surgical repair for transposition of the great arteries (TGA).
• Long-term ASO complications include coronary artery complications, such as stenosis and occlusion.
• Monitoring for coronary artery issues is crucial in TGA patients post-ASO.

Observation:

• A patient presented with severe left main coronary artery stenosis 18 years after undergoing the arterial switch operation for TGA.
• The stenosis significantly impacted blood flow to the left ventricle.
• This complication highlights the potential for late-onset coronary issues after ASO.

Findings:

• The patient underwent successful surgical revascularization using a left internal mammary artery (LIMA) to the left anterior descending (LAD) artery bypass graft.
• The LIMA-LAD bypass provided adequate blood flow, alleviating the stenosis.
• This demonstrates the feasibility of coronary artery bypass grafting in managing late ASO complications.

Implications:

• Coronary artery bypass grafting can be an effective treatment for long-term coronary complications following the arterial switch operation.
• This case underscores the importance of long-term surveillance for coronary artery stenosis in ASO survivors.
• Surgical revascularization offers a viable option for managing complex coronary issues in adult congenital heart disease patients.