Arterial switch operation with coronary arteries from a single sinus in infants.
BACKGROUND
The implantation of a coronary artery (CA) is critical for the arterial switch operation (ASO) done to treat complete transposition of the great arteries (TGA). Coronary artery abnormalities are risk factors for both early and late mortality after surgery. In this study, the methodology and effects of ASO surgery with coronary arteries from a single sinus were evaluated.


RESULTS
From March 1999 to June 2006, 31 patients were treated with ASO with coronary arteries from a single sinus in our hospital. They aged 11 hours 16 months (2.8 +/- 3.9 months) and weighted 2.3 7.8 Kg (3.1 +/- 2.5 Kg). 27 cases had TGA and a ventricular septal defect (VSD), and 4 had TGA and an intact ventricular septum (IVS). During surgery, a CA button was implanted in the new proximal aorta with "trapdoor" technique or by inverting 90 degrees dorsally; pericardium or arterial augmentation was implanted at the base of the new major artery. The mortality rate after surgery was 25.8%. After 2-5 years of follow-up, 2 cases with residual shunting recovered spontaneously, 2 cases had residual pulmonary artery obstruction (30-56 mmHg), and none of the patients had any significant changes in myocardial ischemia.


CONCLUSIONS
The implantation of an abnormal coronary artery is practical and feasible; it can reduce both the occurrence of twisting and deforming in the coronary artery after implantation, as well as myocardial ischemia after surgery. Thus, this could improve the surgical success and cure rates.
Zheng
Jing-Hao
JH
Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, XinHua Hospital, Medical College of Shanghai Jiaotong University, Shanghai, China. haohao6554@hotmail.com
Xu
Zhi-Wei
ZW
Liu
Jin-Fen
JF
Su
Zhao-kang
ZK
Ding
Wen-Xiang
WX
D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*