title: Transposition of Great Arteries with Intramural Coronary Artery: Experience with a Modified Surgical Technique.
abstract: OBJECTIVE
  Transposition of the great arteries is a common congenital heart disease. Arterial switch is the gold standard operation for this complex heart disease. Arterial switch operation in the presence of intramural coronary artery is surgically the most demanding even for the most experienced hands. We are presenting our experience with a modified technique for intramural coronary arteries in arterial switch operation.
  
  
  METHODS
  This prospective study involves 450 patients undergoing arterial switch operation at our institute from April 2006 to December 2013 (7.6 years). Eighteen patients underwent arterial switch operation with intramural coronary artery. The coronary patterns and technique used are detailed in the text.
  
  
  RESULTS
  The overall mortality found in the subgroup of 18 patients having intramural coronary artery was 16% (n=3). Our first patient had an accidental injury to the left coronary artery and died in the operating room. A seven-day old newborn died from intractable ventricular arrhythmia fifteen hours after surgery. Another patient who had multiple ventricular septal defects with type B arch interruption died from residual apical ventricular septal defect and sepsis on the eleventh postoperative day. The remainder of the patients are doing well, showing a median follow-up duration of 1235.34±815.26 days (range 369 - 2730).
  
  
  CONCLUSIONS
  Transposition of the great arteries with intramural coronary artery is demanding in a subset of patients undergoing arterial switch operation. We believe our technique of coronary button dissection in the presence of intramural coronary arteries using coronary shunt is simple and can be a good addition to the surgeons' armamentarium.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Asarwa, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Mishra
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Asarwa, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Asarwa, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Hinduja
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Asarwa, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Wadhawa
authors.affiliation: Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Center, Asarwa, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Patel
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Asarwa, India.
authors.forename: Nikunj
authors.initials: N
authors.lastname: Vaidhya
authors.affiliation: Department of Perfusion, U.N. Mehta Institute of Cardiology and Research Center, Asarwa, India.
authors.forename: Dayesh
authors.initials: D
authors.lastname: Rodricks
authors.affiliation: Mehta Institute of Cardiology and Research Center, Asarwa, India.
authors.forename: Hardik
authors.initials: H
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000069278:Arterial Switch Operation / Q000379:methods* / Q000401:mortality; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D015203:Reproducibility of Results; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult