title: Excellent Long-Term Outcomes of the Arterial Switch Operation in Patients With Intramural Coronary Arteries.
abstract: BACKGROUND
  Intramural coronary arteries may complicate coronary artery transfer during the arterial switch operation. We sought to determine the long-term outcomes of 28 patients with intramural coronary arteries who underwent an arterial switch operation at a single institution.
  
  
  METHODS
  All patients who had intramural coronary arteries and underwent an arterial switch operation were identified from the hospital database and retrospectively reviewed.
  
  
  RESULTS
  From 1983 to 2009, 720 patients underwent an arterial switch operation at our institution. Twenty-eight (3.9%, 28 of 720) had intramural coronary arteries. Patients with intramural coronary arteries had transposition of the great arteries (96%, n = 27) or Taussig-Bing anomaly (4%, n = 1). There were no deaths. Follow-up was 100% complete. Mean follow-up was 16.3 years (median, 15.5 years; range, 5.6 to 26.9 years). No patient required reoperation or catheter reintervention on the coronary arteries. Freedom from reoperation was 93% at 10 years. No patient had more than mild aortic regurgitation at last follow-up. Nine (32%, 9 of 28) patients had coronary angiograms at median 16 months (range, 14 months to 17 years) after arterial switch operation. All patients were asymptomatic at the time of angiogram. One patient had mild stenosis of the circumflex coronary artery demonstrated on a routine coronary angiogram 14 months postoperatively. All 28 patients were asymptomatic and in New York Heart Association functional class I at last follow-up.
  
  
  CONCLUSIONS
  Patients with intramural coronary arteries are not at increased risk of death or coronary reinterventions and have excellent late outcomes after the arterial switch operation.
authors.affiliation: Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Tyson A
authors.initials: TA
authors.lastname: Fricke
authors.affiliation: Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Anne Eva
authors.initials: AE
authors.lastname: Bulstra
authors.affiliation: Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Phillip S
authors.initials: PS
authors.lastname: Naimo
authors.affiliation: Princess Margaret Hospital for Children, Perth, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bullock
authors.affiliation: The Women's and Children's Hospital, Adelaide, Australia.
authors.forename: Terry
authors.initials: T
authors.lastname: Robertson
authors.affiliation: Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
authors.affiliation: Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.affiliation: Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia. Electronic address: igor.konstantinov@rch.org.au.
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
mesh_terms: D000069278:Arterial Switch Operation; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome