Aortocoronary flap technique in arterial switch for single coronary: Two case reports

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Transposition of the great arteries (TGA) with single coronary ostium and intramural coronary arteries presents surgical challenges.
• Classic coronary button implantation during arterial switch operation (ASO) risks coronary insufficiency due to vessel kinking or twisting.

Purpose of the Study:

• To evaluate the efficacy of the aortocoronary flap technique for coronary button transfer in patients with TGA and complex coronary anomalies.
• To present a case series demonstrating the application and outcomes of this technique.

Main Methods:

• The aortocoronary flap technique was employed for coronary button transfer in two pediatric patients undergoing ASO.
• Patients had transposition of the great arteries (one with Taussig-Bing anomaly) and single coronary ostium with intramural course.
• Compared to alternative methods like right subclavian artery augmentation or graft reconstruction, the flap technique avoids compromising arm circulation or introducing thrombotic risks.

Main Results:

• Postoperative evaluations revealed no ST-segment changes or regional wall motion abnormalities in either patient.
• Intensive care unit (ICU) stays were 21 and 14 days, with overall postoperative lengths of stay of 26 and 17 days, respectively.
• The aortocoronary flap technique successfully facilitated coronary transfer without immediate complications.

Conclusions:

• The aortocoronary flap technique is a viable and promising method for coronary button implantation in patients with single ostium and intramural coronary arteries undergoing ASO.
• This technique effectively mitigates the risk of coronary insufficiency associated with vessel kinking and twisting in complex TGA cases.