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SINGLE SINUS CORONARY ARTERIES WITH INTERARTERIAL COURSE IN TGA
Bastien Provost, MD1, Viktoria Weixler, MD2, Emre Belli1
1Hopital Marie Lannelongue, Le Plessis Robinson, France, 2Sickkids, Toronto, ON, Canada
Objective(s): Despite major advances in the surgical repair of transposition of the great arteries (TGA) over the past four decades, unusual coronary artery patterns remain associated with worse outcomes. In particular, single-sinus coronary arteries with interarterial course significantly increase the risk of coronary compression, kinking, or tension post-transfer, which can compromise myocardial perfusion and lead to early failure.Methods: We report two neonates with TGA and single-sinus coronary anatomy with interarterial course. Both had coronary arteries arising from the sinus 2, one with an intramural segment and the other with true single coronary artery. Preoperative echocardiography suspected the anatomy in each case.
Results: In both patients, coronary transfer was tailored to the individual anatomy. A generous incision was used to mobilize the coronary cuff. When intramural course is present and/or distance between coronary is sufficient, unroofing was performed to split the coronary arteries into two buttons. In case of true single coronary artery, a patch augmentation technique was used to enlarge the neo-ostium and limit the risk ok kinking.
Conclusions: Successful coronary transfer in TGA with single-sinus, interarterial anatomy requires a meticulous, anatomy-specific approach. Techniques such as wide cuff harvesting, commissure detachment, unroofing, patch augmentation and trapdoor incision can mitigate the risks associated with this challenging configuration. Detailed preoperative imaging and surgical flexibility are essential to optimize outcomes and prevent ischemic complications.
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