Coronary events after arterial switch operation for transposition of the great arteries.

Abstract:

BACKGROUND:Transfer of the coronary arteries is a crucial step during the arterial switch operation (ASO) for transposition of the great arteries. This retrospective study aims to assess the incidence and risk factors of coronary events after ASO and sensitivity of noninvasive tests in the diagnosis of the coronary obstruction. METHODS AND RESULTS:Between 1982 and 2001, 1304 newborn and infants had an ASO and the 1 198 hospital survivors had a 59-month mean follow-up. Coronary events occurred in 94 patients (7.2%; 95% CI, 6 to 9). Survival without coronary events were 92.7, 91, and 88.2% at 1, 10, and 15 years, respectively. The incidence was bimodal: high early and slow later. Multivariate analysis showed correlation with type B or C coronary pattern and major operative events (P<0.0001 and P=0.0024). In a subset of 324 patients who underwent a coronary artery angiography, lesions were observed in 22 patients (6.8%; 95% CI, 5 to 10). Multivariate analysis showed correlation with only type B or C coronary pattern (OR=20.8, P=0.0002). All of these patients had electrocardiogram and echocardiogram, 174 patients also had a treadmill test, and 115 patients had a myocardial scintigraphy. The association of these tests had the highest diagnosis sensitivity, 75%. CONCLUSIONS:After ASO, coronary events are not rare, occurring most often early and are an important cause of death. Coronary repair can be needed lately. Noninvasive tests are not sensitive enough to detect significant delayed coronary artery stenosis and coronary artery angiography should be performed.

journal_name

Circulation

journal_title

Circulation

authors

Legendre A,Losay J,Touchot-Koné A,Serraf A,Belli E,Piot JD,Lambert V,Capderou A,Planche C

doi

10.1161/01.cir.0000087902.67220.2b

subject

Has Abstract

pub_date

2003-09-09 00:00:00

pages

II186-90

eissn

0009-7322

issn

1524-4539

pii

108/10_suppl_1/II-186

journal_volume

108 Suppl 1

pub_type

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