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

Single coronary ostium and intramural coronary artery variations in patients with transposition of the great arteries significantly increase the mortality and morbidity after arterial switch operation (ASO). In these patients, the classic coronary button implantation may cause kinking or twisting of the coronary artery which can cause coronary insufficiency. This case series presents two patients, a 15-month-old girl with transposition of the great arteries and a 10-month-old boy with a Taussig-Bing anomaly. Both underwent ASO using the aortocoronary flap technique for coronary button transfer. The coronary augmentation with the right subclavian artery technique compromises the circulation to the arm. Meanwhile, the graft reconstruction needs a tunnel/tube, thus causing risk for thrombosis. Hence, aortocoronary flap technique was preferred in this case report. Postoperative evaluations showed no ST-segment changes and no regional wall motion abnormalities. Intensive care unit (ICU) stay after ASO was 21 days and 14 days, and postoperative length of stay was 26 days and 17 days, respectively. Aortocoronary flap technique is a promising method for coronary button implantation in patient with single ostium and intramural coronary artery to prevent coronary insufficiency due to twisting and kinking of the coronary artery.