Coronary arteries in long-term follow-up after arterial switch operation – morphometric study

  • Dr Maciej Moll, Department of Cardiac Surgery, Polish Mother’s Memorial Hospital - Research Institute, Poland
  • Prof Andrzej Sysa, Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lódz, Poland
  • Dr Pawel Dryzek, Polish Mothers' Memorial Hospital, Lodz, Poland
  • Dr Katarzyna Mludzik, Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lódz, Poland
  • Dr Marek Kopala, Department of Cardiosurgery, Polish Mother’s Memorial Hospital, Research Institute, Lódz, Poland
  • Dr Tomasz Moszura, Department of Cardiology Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
  • Prof Jadwiga Moll, Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lódz, Poland
  • Prof Jacek Moll, Department of Cardiac Surgery, Polish Mother’s Memorial Hospital - Research Institute, Poland

    • Background: Coronary transfer is the most crucial part of the arterial switch procedure. In 33% of all the patients with TGA atypical coronary pattern is found. Morphometric study of coronary arteries in patients 6 to 10 years after ASO was performed to assess the long-term outcome of the operation.

    Material and method: Between 1992 and 2007 496 children with TGA underwent arterial switch operation. In 136 of these patients (aged 6 to 10 years) selective coronary arteriography was performed. In each case coronary pattern was analyzed. Indexed diameter and cross-section area of LAD, Cx and RCA divided by BSA was measured.
    Patients were divided into 3 groups:
    1. TGA, IVS– 87pts
    2. TGA and VSD – 39pts
    3. TGA with anomalies of the aortic arch -10pts
    Further, every group was divided into subgroup with typical (T) and anomalous (A)coronary anatomy.
    The indexed diameter of LAD, Cx and RCA was compared between groups and subgroups.
    Results: In group 1 there was a significant difference (p<0,001) in the indexed diameter of Cx between patients T and A. Cx/BSA was higher in group A.
    In group 2 there was a significant difference (p< 0,006) in the diameter of indexed RCA between patients T and A. RCA/BSA was higher in group with T.
    Indexed diameter of RCA was significantly higher comparing groups 1 and 2 in patients with T.
    Conclusions: Size of the coronary arteries post ASO depends on coronary artery anatomy and the coexistence of VSD.