ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
Methods for the Translocation of Coronary Arteries in Arterial Switch Procedures
Tayyar SARIOĞLU, Barbaros KINOĞLU, M. Salih BİLAL, Ayşe SARIOĞLU, Ertan SAĞBAŞ, Yusuf YALÇINBAŞ, Serap TEKİN, Atıf AKÇEVİN, Rüstem OLGA, Aydın AYTAÇ
İ. Ü. Kardiyoloji Enstitüsü Kalp Damar Cerrahisi ve Anesteziyoloji Anabilim Dalları, İstanbul

In the anatomic correction of transposition of the great arteries (TGA), the most important point affecting the early and the long erm results of the arterial switch procedure is the translocation of the coronary ostia to the neoaorta. Between 1990 and 1996, arterial switch procedure have been performed on 84 patients with TGA at our clinic. The age of the patients ranged from 2 days to 11 months. According to the Leiden convention, usual coronary pattern in 64 patients (left anterior descending artery and circumflex artery (RCA) originating from simus 2) and 7 different anatomic configurations in 20 patients have been identified. Among those 20 patients, 10 patients had LAD artery originating from sinus 1 and 10 patients had LAD artery originating from sinus 1 and RCA+Cx artery originating from sinus 2, 4 patients had a single coronary orifice (coronary orifice originating from sinus 1 in two patients and coronary orifica origating from sinus 2 in two patients), one patient had inverted RCA and Cx artery and 5 patients had intramural left main coronary artery or LAD artery. Owerall mortality of the 61 patients operated since August 1992 was 9.8 % (6/61). Poor coronary perfusion has been determined to be the cause of death in two patients. One patient having intramural coronary configuration died in the first postoperative day due to the compression of the left coronary origin by the neoaorta because of the side by side configuration of te great arteries. One patient whose circumflex and right coronary arteries originated from sinus 2 and the LAD artery originated from sinus 1 died as a result of myocardial infarction in the third postoperative month. Coronary angiography of this patient performed in emergency conditions confirmed an occluded LAD artery. Finally, our clinical experiences support the suggestion that the coronary anatomy does not constitute a contraindication to arterial switch procedures and the translocation problems in the coronary artery variations could be overcome by technical modifications such as coronary implantation higher than usual on the proximal neoaorta, excision of the ostia as a single button and anastomosis without rotation with pericardial roofing patch and comissure taken down and resuspension.

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