Abstract

OMPLEX CORONARY PATTERN AFFECTING THE SURGICAL OUTCOME OF ARTERIAL SWITCH OPERATION

Author(s): Amit Mishra 1 , Nikunj Vaidhya 2 , Hardik Patel 3 , Ramesh Patel 4 , Imelda Jain 5 , Harshil Joshi 6 , Komal Shah 7 , Himani Pandya 8

Arterial switch operation (ASO) has become the procedure of choice for the transposition of great arteries as well as for TaussigBing anomaly. Relocation of coronary arteries remains a technical problem in anatomic correction of the transposed great arteries. The present prospective study is designed to analyse the effect of coronary artery pattern on surgical outcome of arterial switch operation. METHOD From August 2014 to November 2015, total 60 patients underwent ASO. The patients are divided in three groups. Group-A 21 patients with d-TGA with intact ventricle septum (d-TGA intact IVS), in Group-B 33 patients d-TGA with ventricular septal defect (d-TGA, VSD), and in Group C 6 Taussig Bing anomaly. The coronary pattern and outcome is analyzed. RESULTS The overall mortality related to coronary pattern was 5%. The 2 patients died due to Intramural coronary artery leading to postoperative ventricular dysfunction, another patient with single retro pulmonary coronary artery died secondary to low coronary implant leading to kinking in coronary artery and myocardial dysfunction. On 12 monthly follow up, one of the Patients in group A had right pulmonary artery stenosis with gradient of 30 mm of Hg. Another patient in group B had supravalvular gradient of 20 mm of Hg. CONCLUSION The ASO for TGA and Taussig-Bing anomaly has low early and late mortality. However, the mortality is still seen in the patients with Intramural coronary artery and in the patient with single coronary artery with retro pulmonary course.