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Eur J Cardiothorac Surg 2007;31:894-898. doi:10.1016/j.ejcts.2007.02.003
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Late coronary artery lesions after neonatal arterial switch operation: results of surgical coronary revascularization

^a Department of Pediatric Cardiac Surgery, University Paris Descartes and Sick Children Hospital, Paris, France
^b Department of Pediatric Cardiology, University Paris Descartes and Sick Children Hospital, Paris, France

Received 19 December 2006; received in revised form 1 February 2007; accepted 2 February 2007.

^_* Corresponding author. Address: Pediatric Cardiac Surgery, Sick Children Hospital, 149 rue de Sèvres, 75015 Paris, France. Tel.: +33 1 44 38 18 67; fax: +33 1 44 38 19 11. (Email: pascal.vouhe{at}nck.aphp.fr).

Objective: To evaluate the results of surgical revascularization in children with coronary artery lesions following neonatal arterial switch operation (ASO). Methods: Among 755 neonates who underwent ASO, there were 713 late survivors (94%). Coronary lesions were detected in 34 patients (5%). Coronary revascularization was carried out in 19 children (mean age: 5.6 ± 3.2 years) in whom myocardial ischemia was demonstrated by myocardial perfusion imaging studies. Coronary lesions involved the left main coronary artery in 14 cases, the left anterior descending artery in 3, and the right coronary artery in 2. Sixteen patients had coronary angioplasty (left main coronary artery in 11, left anterior descending artery in 3, right coronary artery in 2). Two patients underwent a mammary bypass and one had a saphenous vein proximal bypass. Results: There was no mortality or coronary event. Mean follow-up was 6.3 ± 2.8 years. Patency of coronary repair was demonstrated in all patients; however, in one child with angioplasty of the left main coronary artery, there was a residual stenosis of the left anterior descending artery, and reoperation with a mammary bypass was required. Myocardial perfusion imaging was performed in 18 patients; myocardial perfusion was normal in 16 and 2 had minimal residual perfusion defects. Treadmill exercise testing was performed in 11 patients and was normal in all. Conclusions: (1) Following ASO, coronary lesions are not uncommon and they are progressive. Routine and sequential coronary evaluation is necessary. (2) Coronary revascularization can be achieved using coronary angioplasty in most cases. Mammary bypass may be used in selected circumstances. Normal myocardial perfusion is restored in most patients.

Key Words: Arterial switch operation • Coronary lesions • Surgical revascularization

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