Can we predict potentially dangerous coronary patterns in patients with transposition of the great arteries after an
Krzysztof W Michalak1, Katarzyna Sobczak-Budlewska1, Jacek J Moll2
1Department of Cardiology, Polish Mother's Memorial Hospital, Lodz, Poland.
Insights
Coronary CT angiography is crucial for detecting dangerous coronary abnormalities after arterial switch operations in patients with transposition of the great arteries. Routine screening cannot predict these complex configurations, necessitating advanced imaging for effective post-operative management.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Diagnostic Imaging
Background:
- Coronary artery complications are a primary cause of early mortality following arterial switch operations.
- Late complications are infrequent, with no established guidelines for routine coronary artery follow-up or optimal assessment methods.
- This study investigates long-term coronary abnormalities in asymptomatic patients after arterial switch operation using coronary CT angiography.
Purpose of the Study:
- To determine the long-term frequency of coronary abnormalities in asymptomatic patients post-arterial switch operation.
- To identify potential "red flags" for coronary issues using various examinations.
- To evaluate the utility of coronary CT angiography in detecting these abnormalities.
Main Methods:
- A cohort of 50 asymptomatic patients underwent routine long-term coronary artery evaluation post-arterial switch operation.
- Evaluations included medical interviews, ECG, echocardiography, Holter monitoring, lab tests, and cardiopulmonary exercise tests.
- Perfusion scintigraphy was performed for patients with significant abnormalities.
Main Results:
- Sixty percent (30/50) of patients exhibited unfavorable coronary abnormalities.
- Detected abnormalities included ostial stenosis, muscular bridge, coronary fistula, interarterial course, and proximal kinking/acute angulation.
- These features were not predictable via medical history, surgical reports, or non-invasive screening.
Conclusions:
- Complex coronary configurations with potentially dangerous features are common after arterial switch operations for transposition of the great arteries.
- Indirect methods and routine screening cannot identify high-risk patients.
- Coronary CT angiography provides essential, accurate information for post-operative management.
Introduction:
Coronary artery complications are the main reason for early mortality after an arterial switch operation. Late complications are relatively rare, and there is no consensus regarding the need or indications for routine follow-up coronary artery evaluations or the best first-line assessment modality. The aim of this study was to present the long-term post-operative frequency of coronary abnormalities in asymptomatic patients with transposition of the great arteries discovered by coronary CT angiography and potential "red flags" revealed by other examinations.
Patients And Methods:
A group of 50 consecutive asymptomatic patients who underwent routine long-term coronary artery evaluation after an arterial switch operation according to our institutional protocol were qualified for this study. This routine in-hospital visit included a detailed medical interview, electrocardiography, echocardiography, Holter electrocardiography examinations, and laboratory and cardiopulmonary exercise tests. Patients who showed significant abnormalities were qualified for perfusion scintigraphy.
Results:
Unfavourable coronary abnormalities were detected in 30 patients (60%) and included ostial stenosis, muscular bridge, coronary fistula, interarterial course, proximal kinking, high ellipticity index, proximal acute angulation (<30 degree) of the left coronary artery, and proximal acute angulation of the right coronary artery. These features could not be predicted based on the medical interviews, surgical reports, or non-invasive screening test results.
Conclusion:
Complex coronary configurations with potentially dangerous coronary features are common in patients with transposition after an arterial switch operation. Such high-risk patients cannot be identified indirectly, and coronary CT angiography provides accurate information that is useful for post-operative management.
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