LONG-TERM FATE OF THE CORONARY-ARTERIES AFTER THE ARTERIAL SWITCH OPERATION IN NEWBORNS WITH TRANSPOSITION OF THE GREAT-ARTERIES

Objective - Concern continues to be expressed about the long-term impa ct of coronary artery translocation after the arterial switch operatio n for transposition of the great arteries. This study was conducted to determine the prevalence of obstructions of the translocated coronary arteries by the use of selective coronary artery angiography. Methods and results - 64 children (mean age 7.6 (SD) 1.5 years) who had survi ved an arterial switch operation underwent evaluation. They had been o perated on by one surgeon and they were followed up by a single hospit al. Selective coronary artery angiography was possible in 58 patients. Five patients showed occlusion or stenosis of a coronary artery: occl usion and two stenoses of the coronary trunk, two occlusions of the ci rcumflex artery. The prevalence of late coronary artery complications was 7.8 (SD) 6.6% (95% CI 1.2 to -14.4%). The three patients with occl usion of one coronary artery had perioperative ischaemic complications , with associated electrocardiogram evidence of ischaemia and left ven tricular dysfunction with mitral valve insufficiency. Both patients wi th stenosis of the left main coronary artery trunk did not have any ev idence of an anomaly before catheterisation. Conclusions - The prevale nce of the late coronary artery complications after an arterial switch operation was low in this series. This accords with the view that the arterial switch operation remains the preferred treatment for such pa tients. Screening for late coronary artery patency should be done by u sing selective coronary artery angiography, because even patients who remain symptom free can have coronary artery anomalies.