Single coronary artery and complete transposition of the great arteries: a technical challenge resolved?
BACKGROUND
The origin of the coronary arteries from a single aortic sinus remains a rare congenital anomaly, once regarded as having little clinical significance. Contemporary surgical practice, however, frequently demands precise coronary reimplantation. In this article we emphasize a prophylactic surgical technique found especially helpful in the repair of D-transposition of the great arteries (D-TGA)/single coronary artery.


METHODS
We reviewed the institutional cardiac registry.


RESULTS
Since 1985, 398 neonates with D-TGA were repaired with the arterial switch procedure. A mortality rate of 38% was encountered in "simple" D-TGA (n = 174)/single coronary (2.9% left facing sinus (IRLCx), 7.5% right facing sinus (IIRLCx)) and 41% in neonates with D-TGA (n = 224)/single coronary (3.6% IRLCx, 12% IIRLCx). During the past 3.5 years the surgical mortality rate of neonates (n = 6) treated with origin of the coronary arteries from a single aortic sinus has dropped to 0%.


CONCLUSIONS
The surgical repair of D-TGA/single coronary artery continues to trouble surgeons. The implantation of a well-mobilized coronary "button" into a previously anastomosed neoaorta remains a key prophylactic technique in the achievement of good technical results.
Shukla
V
V
Division of Cardiovascular Surgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada.
Freedom
R M
RM
Black
M D
MD
D006348:Cardiac Surgical Procedures; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D012189:Retrospective Studies; D015996:Survival Rate; D014188:Transposition of Great Vessels / Q000150:complications / Q000401:mortality / Q000601:surgery*