Long-Term Coronary Artery Complications Following the Arterial Switch Operation for Transposition of the Great
Rachel S Lim1, Jeffrey Lefkovits2,3, Samuel Menahem3,4,5
1Department of Medical Education, University of Melbourne, Parkville, Victoria, Australia.
Insights
Long-term coronary artery complications after arterial switch operation (ASO) for transposition of the great arteries are rare but challenging to detect due to nonspecific symptoms. Diagnosis and management involve advanced imaging and percutaneous interventions.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Complications
Background:
- The arterial switch operation (ASO) is a standard surgical procedure for transposition of the great arteries.
- Long-term surveillance for coronary artery complications post-ASO is crucial as patients age and face adult comorbidities.
- Understanding the incidence and characteristics of late coronary issues is vital for improved patient outcomes.
Approach:
- A comprehensive scoping review was conducted to identify and synthesize existing literature on long-term coronary artery complications after ASO.
- Seventy-three relevant articles were selected based on predefined criteria.
- The review focused on incidence, clinical presentation, diagnostic methods, and management strategies.
Key Points:
- Long-term coronary artery complications following ASO are infrequent.
- Clinical manifestations are often subtle, absent, or nonspecific, complicating early recognition.
- Coronary angiography and CT scans are key diagnostic tools for suspected coronary involvement.
- Percutaneous trans-catheter interventions are the primary treatment for significant coronary stenosis.
Conclusions:
- While rare, long-term coronary artery complications after ASO require vigilant monitoring.
- Nonspecific symptoms necessitate a high index of suspicion for coronary issues in ASO survivors.
- Timely diagnosis and intervention, particularly percutaneous methods, are essential for managing these complications.
Abstract:
Coronary artery complications following the arterial switch operation (ASO) for transposition of the great arteries have become increasingly relevant as those affected are exposed to the comorbidities of later years. A scoping review was undertaken to explore the incidence, clinical features, and management of the long-term coronary complications after the ASO. The selection criteria yielded 73 articles They recorded few long-term coronary artery complications following the ASO, which were difficult to recognize as most affected patients' symptoms were absent or nonspecific. In patients with suspected coronary artery involvement, coronary angiography or computed tomography provided confirmation, with significant stenosis generally managed by percutaneous trans-catheter interventions.
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