Coronary artery ectasia in a child after arterial switch operation for transposition of the great arteries and suspected multisystem inflammatory syndrome in children associated with COVID-19: a case report

Abstract Background Multisystem inflammatory syndrome in children (MIS-C) with features resembling Kawasaki disease has been reported in association with coronavirus disease 2019 (COVID-19). Case summary We report the rare case of a 22 months old boy with a history of operated simple transposition of the great arteries (TGA), who developed features of MIS-C likely to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection and involving the coronary arteries. Cardiovascular magnetic resonance imaging and cardiac catheterization showed long-distance ectasia of both coronary arteries after their origins and an origin stenosis of the right coronary artery with a perfusion defect. The patient was treated with oral anticoagulation together with antiplatelet therapy and remains under careful monitoring. Discussion This rare case demonstrates that also patients with TGA after the arterial switch operation (ASO) can develop coronary artery dilatation in association with MIS-C. The most interesting finding in this patient was that the origins of the reimplanted coronary arteries were not dilated. We speculate that scar tissue formation in the area of coronary artery transfer after ASO has prevented proximal coronary artery dilation.

Download Full-text

Preoperative identification of coronary arterial anatomy in complete transposition, and outcome after the arterial switch operation

Cardiology in the Young ◽

10.1017/s1047951102000537 ◽

2002 ◽

Vol 12 (3) ◽

pp. 240-247 ◽

Cited By ~ 15

Author(s):

Colin J. McMahon ◽

Howaida G. El Said ◽

Timothy F. Feltes ◽

Carmen H. Watrin ◽

Beth A. Hess ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Left Coronary Artery ◽

Arterial Switch Operation ◽

Circumflex Coronary Artery ◽

Arterial Switch ◽

Complete Transposition ◽

Switch Operation ◽

The Right ◽

Arterial Anatomy

Background: Perceived correlation between the coronary arterial anatomy in patients with complete transposition, and the outcome of the arterial switch procedure, has made preoperative identification of their patterns standard practice. Purpose: Our purpose was to assess the accuracy of preoperative echocardiographic identification of coronary arterial patterns, to evaluate the necessity of preoperative imaging by angiography, and to determine the impact of the coronary arterial anatomy on outcome. Methods: We reviewed the medical records of all patients referred for an arterial switch operation between August 1995 and January 2000. The anatomy as described at the time of the operation using the Leiden convention was compared to the preoperative echocardiographic and angiographic findings. Results: The procedure had been performed in 67 patients, at a mean age of 9 days, with a range from 3 days to 15 months. In 42 patients, the ventricular septum was intact, while 21 patients had a ventricular septal defect, and the other four had double outlet right ventricle with the aorta anterior and rightward. In 52 patients, the left coronary artery arose from sinus #1, and the right from sinus #2. In 8 patients, the interventricular branch of the left coronary artery arose from sinus #1, with the circumflex coronary artery arising together with the right coronary artery from sinus #2. In three patients, all three coronary arteries arose from sinus #1, while in the remaining individual patients, a large conal branch arose with the left coronary artery from sinus #1, the right coronary and left anterior descending arteries arose from sinus #1, all three coronary arteries took origin from sinus #2, and the left anterior descending and right coronary artery arose from sinus #1 with no circumflex coronary artery identifiable, respectively. In two patients (4%), we identified an intramural coronary arterial course. Echocardiography and angiography were comparable (81% versus 86%) in delineating the coronary arterial anatomy. Patients with a single arterial orifice, or an atypical coronary arterial anatomy, had a slightly longer stay on the intensive care unit, and in the hospital, but showed no difference in mortality. In fact, there was no early mortality (70% confidence limits; 0–2.9%), while two patients died late (2.9%). Conclusion: We conclude that complex coronary arterial anatomy does not preclude a successful arterial switch procedure, although patients with a single coronary artery, or other arterial patterns, had a slightly longer hospital course. Preoperative echocardiographic evaluation is comparable to non-selective coronary angiography. Irrespective of complexity, nonetheless, the coronary arteries can successfully be translocated, obviating the need for preoperative coronary angiography.

Download Full-text

Right Coronary Artery May Grow Even Better than Normal After Arterial Switch Operation for Complete Transposition of the Great Arteries

10.21203/rs.3.rs-96030/v1 ◽

2020 ◽

Author(s):

Daisuke Machida ◽

Yukihisa Isomatsu ◽

Motohiko Goda ◽

Shinichi Suzuki ◽

Keiichiro Kasama ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Coronary Arteries ◽

Arterial Switch Operation ◽

Control Group ◽

Transposition Of Great Arteries ◽

Arterial Switch ◽

Complete Transposition ◽

Switch Operation ◽

The Right

Abstract Background: It is unclear if coronary arteries properly grow in patients who underwent arterial switch operation for complete transposition of the great arteries. The purpose of this study was to clarify the mode of coronary growth and size in these patients. Methods: Eighteen patients who underwent arterial switch operation for complete transposition of the great arteries from 2000 to 2012 in our institution, and in whom coronary angiography was performed in late operative phase, were enrolled in this study. Growth of coronary arteries was evaluated by cubage of coronary arteries based on analyses with coronary angiography. Coronary arteries were divided into small segments and each segment was approximated by a truncated right circular cone. The sum of the cubage of each truncated cone in one coronary artery was approximated as total cubage of the coronary. the coronary cubage index was then calculated by dividing total cubage of a coronary artery by the patient’s body surface area. The coronary cubage indexes of the enrolled patients were compared with that of control patients with healed Kawasaki disease.Results: The left coronary cubage indexes of the complete transposition of the great arteries group and the control group were 1.05 ± 0.34 and 0.94 ± 0.34 (p=0.598), respectively, and no significant deference was found between groups. On the contrary, the right cubage index of the complete transposition of great arteries group was significantly larger than the control group (1.08 ± 0.44 and 0.54 ± 0.37, respectively; p=0.007), and total coronary cubage index (left coronary index + right coronary index) of the complete transposition of the great arteries group was also larger than the control group as well (2.13 ± 0.7 and 1.47 ± 0.6, respectively; p=0.026).Conclusion: The left coronary arteries after arterial switch operation for complete transposition of great arteries grow as large as normal; however, the right coronary arteries possibly grow even larger.

Download Full-text

Paediatric coronary artery bypass grafting for coronary hypoperfusion late after arterial switch operation

Cardiology in the Young ◽

10.1017/s1047951111000138 ◽

2011 ◽

Vol 21 (4) ◽

pp. 460-461 ◽

Cited By ~ 2

Author(s):

Farhad Bakhtiary ◽

Wilfried Bellinghausen ◽

Martin Kostelka

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Arterial Switch Operation ◽

Artery Bypass ◽

Off Pump ◽

Arterial Switch ◽

Main Coronary Artery Stenosis ◽

Switch Operation ◽

Pump Coronary Artery Bypass ◽

The Right

AbstractA case of left main coronary artery stenosis is presented in a boy late after an arterial switch operation, with significant ischaemia during exercise with good collateralisation through the right coronary artery. The problem was successfully managed with minimally invasive off-pump coronary artery bypass through median re-sternotomy.

Download Full-text

Corridor technique for coronary arteries from a single arterial sinus

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320937506 ◽

2020 ◽

Vol 28 (6) ◽

pp. 333-335

Author(s):

Kota Agematsu ◽

Mitsugi Nagashima ◽

Yoshiharu Nishimura ◽

Takashi Higaki

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Arterial Switch Operation ◽

Early Mortality ◽

Single Coronary Artery ◽

Coronary Anomalies ◽

Arterial Switch ◽

Switch Operation ◽

Late Morbidity ◽

Independent Risk Factors

The introduction of the arterial switch operation has improved the surgical outcome of transposition of the great arteries. However, coronary anomalies such as intramural coronary arteries, single coronary artery, or coronary arteries originating from a single arterial sinus have been reported as independent risk factors for early mortality and late morbidity after an arterial switch operation. We performed an arterial switch operation using a unique technique for translocation of the coronary arteries originating from a single left-side arterial sinus, to prevent coronary artery distortion and subsequent coronary malperfusion.

Download Full-text

Unusual Intramural Coronary Artery With Vertical Course Complicating an Arterial Switch Operation

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135117723906 ◽

2017 ◽

Vol 10 (2) ◽

pp. 231-234

Author(s):

Lok Sinha ◽

Richard A. Jonas ◽

Pranava Sinha

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Arterial Switch Operation ◽

Ascending Aorta ◽

Sinus Of Valsalva ◽

Arterial Switch ◽

Switch Operation ◽

Technical Modifications ◽

Intramural Coronary Artery

Intramural coronary arteries in patients with d-transposition of the great arteries (d-TGA) usually arise from the opposite sinus of Valsalva and traverse horizontally across the posterior/facing commissure before emerging externally from the appropriate sinus of Valsalva. Failure to make appropriate technical modifications during coronary transfer can result in an important risk of posttransfer ischemia. We report a case with an unusual course of an intramural left anterior descending (LAD) coronary artery in a patient with d-TGA, with origin at the mid ascending aorta and a vertical intramural course, increasing the susceptibility to injury during an arterial switch operation (ASO).

Download Full-text

Percutaneous coronary intervention in a 4-month-old infant for stenosis of both coronary arteries after arterial switch operation for transposition of the great arteries

Cardiology in the Young ◽

10.1017/s1047951121001876 ◽

2021 ◽

pp. 1-3

Author(s):

Hanna Kim ◽

Jinyoung Song ◽

I-Seok Kang

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Coronary Stenosis ◽

Left Coronary Artery ◽

Arterial Switch Operation ◽

Coronary Intervention ◽

Arterial Switch ◽

Switch Operation ◽

Percutaneous Coronary ◽

The Right

Abstract We present a case of percutaneous coronary intervention in a 4-month-old infant with both severe coronary stenosis and acute heart failure after arterial switch operation for transposition of the great arteries. Under extracorporeal membrane oxygenation, balloon angioplasty of the left coronary artery with a 2.0 × 15-mm balloon and stent implantation on the right coronary artery with a 2.25 × 26-mm stent were performed successfully. Echocardiography after the intervention showed recovered cardiac function and no complications.

Download Full-text

The size of the coronary arteries in children with complete transposition before and after the arterial switch operation

Cardiology in the Young ◽

10.1017/s1047951100002316 ◽

1994 ◽

Vol 4 (4) ◽

pp. 340-346 ◽

Cited By ~ 5

Author(s):

Koichi Yatsunami ◽

Makoto Nakazawa ◽

Masashi Seguchi ◽

Kazuo Momma ◽

Yasuharu Imai

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Right Coronary Artery ◽

Arterial Switch Operation ◽

Left Main ◽

Main Trunk ◽

Left Main Trunk ◽

Complete Transposition ◽

Switch Operation ◽

The Right

AbstractThe size of the coronary arteries parallels the ventricular mass, thus it may be abnormal in complete transposition beyond infancy and could be influenced by the arterial switch operation. To investigate this possibility, we measured the diameters of the right, left main trunk, anterior descending, and circumflex coronary arteries before and three to seven years (mean 4.8) after the arterial switch operation in 17 patients with a “normal” distribution of the coronary arteries (so-called Shaher type 1). The values were compared with 18 controls who had Kawasaki disease with no apparent coronary arterial disease. The right, left anterior descending, and circumflex arteries were smaller than control values before the operation. The post-/preoperative ratios of the diameter were 1.16±0.11 for the right coronary artery, 1.18±0.16 for the left main trunk, 1.20±0.18 for the left anterior descending artery, and 1.22±0.26 for the circumflex artery. There were no significant differences among these values. After surgery, the right coronary artery was larger, but the left coronary arteries were smaller in the patients than in the controls: 2.5±0.3 vs 2.0±0.2 mm for the right coronary artery; 2.4±0.3 vs 2.7±0.1 mm for the left main trunk; 1.9±0.2 vs 2.4±0.2 mm for the left anterior descending artery; 1.6±0.4 vs 2.2±0.5 mm for the circumflex artery, respectively. The posterior descending coronary artery originated from the right coronary artery in all patients. The total cross-sectional area of the right coronary, left anterior descending, and circumflex arteries was 9.7±2.4 mm2in the patients, and 11.8±2.9 mm2in the controls (p>O. 1), suggesting that the increased size of the right coronary artery compensates for the small left coronary arteries. We conclude that the arterial system in complete transposition, with a large right coronary artery and small left coronary system, remains smaller than normal even at midterm follow-up after anatomic repair despite normalization of left ventricular volume and muscle mass.

Download Full-text

Arterial switch operation in non-facing coronary artery ostium

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319825966 ◽

2019 ◽

Vol 27 (6) ◽

pp. 492-494

Author(s):

Thaworn Subtaweesin

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Arterial Switch Operation ◽

Ascending Aorta ◽

Arterial Switch ◽

Switch Operation

The arterial switch operation was performed on a 38-day-old infant with d-transposition of the great arteries and abnormal origin of the left anterior descending and right coronary arteries from a non-facing sinus. A vertical aortic tube flap was established to lengthen the abnormally originating coronary arteries, by transecting part of the ascending aorta 2 cm above the coronary orifices. Both coronary arteries were transferred to the neoaortic root in a single extended tube.

Download Full-text