Surgical treatment of infants with transposition of the great arteries and intramural coronary artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DUN Yaojun ,  SUN Haining , YAN Jun , YANG Keming , HUA Zhongdong , WANG Qiang ,  LI Shoujun

Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;

Corresponding author：

SUN Haining, Email: shnjn@126.com; LI Shoujun, Email: drlishoujun@126.com

Keywords：

Transposition of the great arteries; arterial switch operation; intramural coronary artery; coronary transfer; surgery

DOI：

10.7507/1007-4848.202009001

Video：

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Objective To summarize the surgical experience of infants with transposition of the great arteries (TGA) and intramural coronary artery (IMCA) in our center, and analyze the early and mid-term outcomes.Methods We retrospectively analyzed the clinical data of 384 infants with TGA undergoing arterial switch operation (ASO) from June 2010 to December 2018 at Fuwai Hospital. According to operative records, 21 (5.5%) infants had IMCA, among whom 20 were males, with a median age of 33 (9-319) d. Coronary transfer using double coronary buttons with unroofed intramural course was performed in all 21 infants.Results There was no statistical difference in the early mortality after ASO between infants with IMCA and infants with normal coronary anatomy (9.5% vs. 3.0%, P=0.15). In the IMCA group, 2 dead patients presented inadequate coronary artery perfusion after first aortic unclamping. In addition, 1 patient underwent extracorporeal membrane pulmonary support for myocardial dysfunction. The follow-up was available for all 19 survivors, with an average follow-up time of 29.0-120.0 (74.8±27.3) months. During the follow-up, all patients had no obvious symptoms, death, reoperation, or coronary complications. One patient developed moderate pulmonary valve regurgitation and another patient developed distal stenosis of the right pulmonary artery.Conclusion For infants with TGA and IMCA, coronary transfer using double coronary buttons with unroofed intramural course is a safe and reliable technique, with satisfactory early and mid-term outcomes.

Citation： DUN Yaojun, SUN Haining, YAN Jun, YANG Keming, HUA Zhongdong, WANG Qiang, LI Shoujun. Surgical treatment of infants with transposition of the great arteries and intramural coronary artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 323-329. doi: 10.7507/1007-4848.202009001 Copy

1.	Khairy P, Clair M, Fernandes SM, et al. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation, 2013, 127(3): 331-339.
2.	Jatene AD, Fontes VF, Paulista PP, et al. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg, 1976, 72(3): 364-370.
3.	Villafañe J, Lantin-Hermoso MR, Bhatt AB, et al. D-transposition of the great arteries: The current era of the arterial switch operation. J Am Coll Cardiol, 2014, 64(5): 498-511.
4.	Metton O, Calvaruso D, Gaudin R, et al. Intramural coronary arteries and outcome of neonatal arterial switch operation. Eur J Cardiothorac Surg, 2010, 37(6): 1246-1253.
5.	Schidlow DN, Jenkins KJ, Gauvreau K, et al. Transposition of the great arteries in the developing world: Surgery and outcomes. J Am Coll Cardiol, 2017, 69(1): 43-51.
6.	Freed DH, Robertson CM, Sauve RS, et al. Intermediate-term outcomes of the arterial switch operation for transposition of great arteries in neonates: Alive but well? J Thorac Cardiovasc Surg, 2006, 132(4): 845-852.
7.	Sarris GE, Chatzis AC, Giannopoulos NM, et al. The arterial switch operation in Europe for transposition of the great arteries: A multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg, 2006, 132(3): 633-639.
8.	董念国, 李守军. 先天性心脏病外科治疗中国专家共识(一): 大动脉调转术应用. 中国胸心血管外科临床杂志, 2020, 27(2): 126-132.
9.	Pasquali SK, Hasselblad V, Li JS, et al. Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries: A meta-analysis. Circulation, 2002, 106(20): 2575-2580.
10.	Fricke TA, Bulstra AE, Naimo PS, et al. Excellent long-term outcomes of the arterial switch operation in patients with intramural coronary arteries. Ann Thorac Surg, 2016, 101(2): 725-729.
11.	Fricke TA, Bell D, Daley M, et al. The influence of coronary artery anatomy on mortality after the arterial switch operation. J Thorac Cardiovasc Surg, 2020, 160(1): 191-199.
12.	Thrupp SF, Gentles TL, Kerr AR, et al. Arterial switch operation: Early and late outcome for intramural coronary arteries. Ann Thorac Surg, 2012, 94(6): 2084-2090.
13.	Asou T, Karl TR, Pawade A, et al. Arterial switch: Translocation of the intramural coronary artery. Ann Thorac Surg, 1994, 57(2): 461-465.
14.	Koshiyama H, Nagashima M, Matsumura G, et al. Arterial switch operation with and without coronary relocation for intramural coronary arteries. Ann Thorac Surg, 2016, 102(4): 1353-1359.
15.	Moll M, Moll JA, Moll JJ, et al. Intramural coronary pattern in patients with transposition: Incidence and impact on follow-up. Eur J Cardiothorac Surg, 2020, 58(1): 145-152.
16.	曲艳吉, 罗丹东, 刘小清, 等. 大动脉调转术: 单中心20年571例患者结果的双向队列研究. 中国胸心血管外科临床杂志, 2020, 27(2): 133-141.
17.	Prêtre R, Tamisier D, Bonhoeffer P, et al. Results of the arterial switch operation in neonates with transposed great arteries. Lancet, 2001, 357(9271): 1826-1830.
18.	Qamar ZA, Goldberg CS, Devaney EJ, et al. Current risk factors and outcomes for the arterial switch operation. Ann Thorac Surg, 2007, 84(3): 871-878.
19.	Fricke TA, d'Udekem Y, Richardson M, et al. Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience. Ann Thorac Surg, 2012, 94(1): 139-145.
20.	Aubert J, Pannetier A, Couvelly JP, et al. Transposition of the great arteries. New technique for anatomical correction. Br Heart J, 1978, 40(2): 204-208.
21.	Planché C, Bruniaux J, Lacour-Gayet F, et al. Switch operation for transposition of the great arteries in neonates. A study of 120 patients. J Thorac Cardiovasc Surg, 1988, 96(3): 354-363.
22.	Yacoub MH, Radley-Smith R. Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction. Thorax, 1978, 33(4): 418-424.
23.	Sung SC, Chang YH, Lee HD, et al. Arterial switch operation for transposition of the great arteries with coronary arteries from a single aortic sinus. Ann Thorac Surg, 2005, 80(2): 636-641.
24.	Takeuchi S, Katogi T. New technique for the arterial switch operation in difficult situations. Ann Thorac Surg, 1990, 50(6): 1000.
25.	Cetin G, Tireli E, Ozkara A, et al. Arterial switch operations for single coronary artery ostium or intramural coronary artery. Circ J, 2004, 68(12): 1179-1183.
26.	Suzuki T. Modification of the arterial switch operation for transposition of the great arteries with complex coronary artery patterns. Gen Thorac Cardiovasc Surg, 2009, 57(6): 281-292.
27.	Brawn WJ, Mee RB. Early results for anatomic correction of transposition of the great arteries and for double-outlet right ventricle with subpulmonary ventricular septal defect. J Thorac Cardiovasc Surg, 1988, 95(2): 230-238.
28.	Mishra A, Jain A, Hinduja M, et al. Transposition of great arteries with intramural coronary artery: Experience with a modified surgical technique. Braz J Cardiovasc Surg, 2016, 31(1): 15-21.

1. Khairy P, Clair M, Fernandes SM, et al. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation, 2013, 127(3): 331-339.
2. Jatene AD, Fontes VF, Paulista PP, et al. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg, 1976, 72(3): 364-370.
3. Villafañe J, Lantin-Hermoso MR, Bhatt AB, et al. D-transposition of the great arteries: The current era of the arterial switch operation. J Am Coll Cardiol, 2014, 64(5): 498-511.
4. Metton O, Calvaruso D, Gaudin R, et al. Intramural coronary arteries and outcome of neonatal arterial switch operation. Eur J Cardiothorac Surg, 2010, 37(6): 1246-1253.
5. Schidlow DN, Jenkins KJ, Gauvreau K, et al. Transposition of the great arteries in the developing world: Surgery and outcomes. J Am Coll Cardiol, 2017, 69(1): 43-51.
6. Freed DH, Robertson CM, Sauve RS, et al. Intermediate-term outcomes of the arterial switch operation for transposition of great arteries in neonates: Alive but well? J Thorac Cardiovasc Surg, 2006, 132(4): 845-852.
7. Sarris GE, Chatzis AC, Giannopoulos NM, et al. The arterial switch operation in Europe for transposition of the great arteries: A multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg, 2006, 132(3): 633-639.
8. 董念国, 李守军. 先天性心脏病外科治疗中国专家共识(一): 大动脉调转术应用. 中国胸心血管外科临床杂志, 2020, 27(2): 126-132.
9. Pasquali SK, Hasselblad V, Li JS, et al. Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries: A meta-analysis. Circulation, 2002, 106(20): 2575-2580.
10. Fricke TA, Bulstra AE, Naimo PS, et al. Excellent long-term outcomes of the arterial switch operation in patients with intramural coronary arteries. Ann Thorac Surg, 2016, 101(2): 725-729.
11. Fricke TA, Bell D, Daley M, et al. The influence of coronary artery anatomy on mortality after the arterial switch operation. J Thorac Cardiovasc Surg, 2020, 160(1): 191-199.
12. Thrupp SF, Gentles TL, Kerr AR, et al. Arterial switch operation: Early and late outcome for intramural coronary arteries. Ann Thorac Surg, 2012, 94(6): 2084-2090.
13. Asou T, Karl TR, Pawade A, et al. Arterial switch: Translocation of the intramural coronary artery. Ann Thorac Surg, 1994, 57(2): 461-465.
14. Koshiyama H, Nagashima M, Matsumura G, et al. Arterial switch operation with and without coronary relocation for intramural coronary arteries. Ann Thorac Surg, 2016, 102(4): 1353-1359.
15. Moll M, Moll JA, Moll JJ, et al. Intramural coronary pattern in patients with transposition: Incidence and impact on follow-up. Eur J Cardiothorac Surg, 2020, 58(1): 145-152.
16. 曲艳吉, 罗丹东, 刘小清, 等. 大动脉调转术: 单中心20年571例患者结果的双向队列研究. 中国胸心血管外科临床杂志, 2020, 27(2): 133-141.
17. Prêtre R, Tamisier D, Bonhoeffer P, et al. Results of the arterial switch operation in neonates with transposed great arteries. Lancet, 2001, 357(9271): 1826-1830.
18. Qamar ZA, Goldberg CS, Devaney EJ, et al. Current risk factors and outcomes for the arterial switch operation. Ann Thorac Surg, 2007, 84(3): 871-878.
19. Fricke TA, d'Udekem Y, Richardson M, et al. Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience. Ann Thorac Surg, 2012, 94(1): 139-145.
20. Aubert J, Pannetier A, Couvelly JP, et al. Transposition of the great arteries. New technique for anatomical correction. Br Heart J, 1978, 40(2): 204-208.
21. Planché C, Bruniaux J, Lacour-Gayet F, et al. Switch operation for transposition of the great arteries in neonates. A study of 120 patients. J Thorac Cardiovasc Surg, 1988, 96(3): 354-363.
22. Yacoub MH, Radley-Smith R. Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction. Thorax, 1978, 33(4): 418-424.
23. Sung SC, Chang YH, Lee HD, et al. Arterial switch operation for transposition of the great arteries with coronary arteries from a single aortic sinus. Ann Thorac Surg, 2005, 80(2): 636-641.
24. Takeuchi S, Katogi T. New technique for the arterial switch operation in difficult situations. Ann Thorac Surg, 1990, 50(6): 1000.
25. Cetin G, Tireli E, Ozkara A, et al. Arterial switch operations for single coronary artery ostium or intramural coronary artery. Circ J, 2004, 68(12): 1179-1183.
26. Suzuki T. Modification of the arterial switch operation for transposition of the great arteries with complex coronary artery patterns. Gen Thorac Cardiovasc Surg, 2009, 57(6): 281-292.
27. Brawn WJ, Mee RB. Early results for anatomic correction of transposition of the great arteries and for double-outlet right ventricle with subpulmonary ventricular septal defect. J Thorac Cardiovasc Surg, 1988, 95(2): 230-238.
28. Mishra A, Jain A, Hinduja M, et al. Transposition of great arteries with intramural coronary artery: Experience with a modified surgical technique. Braz J Cardiovasc Surg, 2016, 31(1): 15-21.

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