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DOI: 10.1055/s-0032-1332273
Reverse anastomosis technique for the treatment of a rare coronary artery anomaly in D-Transposition of the great vessels
Introduction: Arterial switch operation (ASO) remains the gold standard surgical therapy for d-transposition of the great vessels. Coronary anomalies may complicate the surgical strategy and lead to an increased morbidity and mortality.
Case report: A 5-month-old male has been transferred from Iraq to our institution with the diagnosis of a D-Transposition of the Great Arteries (D-TGA) with a ventricular septal defect (VSD). Preoperative echocardiography revealed a Taussig-Bing type anatomy with a subpulmonic VSD with inlet extension and a left persistant superior vena cava. Intraoperatively the preoperative diagnosis was confirmed along with almost side-by-side orientation of the great vessels but a coronary anomaly with single origin of the right and left coronary artery from sinus 2 which followed a retropulmonary course. Additionaly, an intramural conal branch of moderate size was originating 3 – 4 mm above the commissure between sinus 1 and non-facing sinus.
Using cardiopulmonary bypass and cardioplegic arrest at 30 °C an ASO with the closure of the VSD was performed. While direct transfer of the single coronary ostium from sinus 2 to the neoaorta was possible using the trap-door technique the juxta-commissural conal branch was transferred to the neoaorta using a reverse anastomosis technique. Thereby, the single high-origin coronary was detached from the aorta and a vertical incision along the proximal course of the coronary was performed in order to allow its translocation to the posterior neo-aorta (Videopresentation, Figure 1).
Fig. 1: Coronary_post-translocation
The patient was weaned from cardiopulmonary bypass in sinus rhythm with minimal inotropic support and was transferred to the floor on the 7th postoperative day. He was discharged home in a good clinical condition on the 17th postoperative day.
Discussion: Even challenging coronary anomalies in the context of D-TGA should not necessarily be a contraindication for the performance of a primary complete repair.