Coronary Artery Bypass Grafting in an Infant after an Arterial Switch Operation

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease Interventions
• Vascular Grafting Techniques

Background:

• Coronary artery bypass grafting (CABG) is infrequently performed in infants due to technical challenges and uncertain long-term outcomes.
• Infants undergoing arterial switch operation (ASO) for transposition of the great arteries are at risk for coronary artery complications.
• Left coronary artery insufficiency following ASO can lead to significant morbidity.

Observation:

• A 90-day-old infant with transposition of the great arteries developed left coronary artery insufficiency post-ASO, despite previous interventions.
• The infant required on-pump beating heart CABG using an internal mammary artery graft to address the coronary insufficiency.
• The left anterior descending artery was revascularized with the graft.

Findings:

• Postoperative computed tomography angiography confirmed the patency of the internal mammary artery graft.
• At 7 months follow-up, the infant showed significant weight gain and preserved ventricular function on echocardiography.
• The CABG procedure successfully restored coronary blood flow and improved cardiac function.

Implications:

• Coronary artery bypass grafting (CABG) can be a safe and effective treatment option for managing coronary complications in early infancy after arterial switch operation (ASO).
• This case highlights the potential of CABG as an alternative strategy when primary reconstructive efforts for coronary arteries fail in neonates and infants.
• Further research into long-term outcomes is warranted, but this suggests a promising approach for complex congenital heart disease management.