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. 2023 Oct 14:14:100481.
doi: 10.1016/j.ijcchd.2023.100481. eCollection 2023 Dec.

Late follow-up of neo-aortic dimensions and coronary arteries in adult patients after the arterial switch operation

Diederick B H Verheijen  1   2 , Leo J Engele  1   3 , Anastasia D Egorova  1   2 , J Lauran Stöger  4 , Bart J A Mertens  5 , Roel L F van der Palen  1   6 , Dave R Koolbergen  1   7 , Mark G Hazekamp  1   7 , J Wouter Jukema  2   8 , Hubert W Vliegen  1   2 , Berto J Bouma  1   3 , Monique R M Jongbloed  1   2   9 , Philippine Kiès  1   2
Affiliations

Late follow-up of neo-aortic dimensions and coronary arteries in adult patients after the arterial switch operation

Diederick B H Verheijen et al. Int J Cardiol Congenit Heart Dis. .

Abstract

Background: After the arterial switch operation (ASO) for transposition of the great arteries (TGA), neo-aortic dilatation and coronary arterial anomalies, especially an interarterial course and acute coronary artery take-off angle, are commonly found. Long-term follow-up data after ASO is scarce. Aim of this study was to determine the prevalence of neo-aortic dilatation and coronary abnormalities, with special emphasis on acute coronary take-off angle, in adult TGA-ASO patients.

Methods: In this retrospective cohort study, all adult TGA-ASO patients with ≥1 CT-angiography (CTA) at the age of ≥16 years were included.

Results: Eighty-one patients, 69 % male and median age 21.0 [18.5-22.8] years, were included. At baseline, maximum neo-aortic diameter was 39.2 ± 5.3 mm; 35 (43 %) patients had neo-aortic dilatation (neo-aortic diameter of >40 mm), 22 (27 %) patients had an acute coronary take-off angle (<30°), and 5 (6 %) patients had an interarterial course of the RCA (2 %) or LCA (4 %). Neo-aortic or coronary artery re-intervention occurred in 10 (12 %) patients. All 10 patients had neo-aortic dilatation or coronary take-off angle of <30° on baseline CTA.

Conclusion: This study reports a prevalence of 43 % of neo-aortic dilatation, 6 % of interarterial coronary course and 27 % for acute coronary take-off angle (<30°) at a median term of 21.0 years post ASO. All patients with a neo-aortic re-intervention or coronary artery re-intervention during follow-up had a maximum neo-aortic diameter of >40 mm or a coronary take-off angle of <30° at baseline CTA. This hypothesis generating study suggests that an active surveillance in patients with neo-aortic dilation and/or an acute angulation of < 30° post ASO might be considered and requires prospective evaluation.

Keywords: Acute take-off angle; Arterial switch operation; Computed tomography angiography; Neo-aortic dilatation; Transposition of the great arteries.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
CTA analysis approach. A–C: 3-dimensional multiplanar reconstruction with double oblique planes perpendicular to the neo-aortic annulus. C: 3-dimensional multiplanar reconstruction plane to additionally measure the distance from the coronary ostium to the neo-aortic annulus. D: Cusp-to-commissure diameter measurements of the neo-aortic root. E: Measurement of the coronary take-off angle. Abbreviations: Ao, aorta; Ao-an, neo-aortic annulus; Ao-Asc, ascending aorta; CTA, computed tomography angiography; LA, left atrium; LCA, left coronary artery; LCC, left coronary cusp; LVOT, left ventricular outflow tract; NCC, non-coronary cusp; PA, pulmonary artery; RCA, right coronary artery; RCC, right coronary cusp; RV, right ventricle; STJ, sinotubular junction.
Fig. 2
Fig. 2
Flow diagram of study design. Abbreviations: CTA, computed tomography angiography; TGA, transposition of the great arteries.
Fig. 3
Fig. 3
CTA images (left column) and corresponding illustrations (right column) presenting the variants of coronary anatomy in patients with transposition of the great arteries after arterial switch operation classified according to the Leiden Convention coronary coding system Abbreviations: 1, sinus 1; 2, sinus 2; Ao, aorta; CTA, computed tomography angiography; LAD, left anterior descending artery; LCA, left coronary artery; LCx, left circumflex artery; NF, non-facing sinus; PA, pulmonary artery, RCA, right coronary artery.
Fig. 4
Fig. 4
Presence of interarterial course, neo-aortic dilatation (>40 mm) and acute coronary take-off angle (<30°) at baseline CTA Abbreviations: CTA, computed tomography angiography.
Fig. 5
Fig. 5
Scatterplots with Pearson’s correlation coefficients illustrating the relation between the coronary take-off angle (°) of the RCA (3A) and LCA (3B) and maximum neo-aortic dimension (mm), the relation between the coronary take-off angle (°) of the RCA (3C) and LCA (3D) and maximum neo-aortic dimension/BSA (mm/m2), and the relation between the coronary take-off angle (°) of the RCA (3E) and LCA (3F) and the distance from the annulus to the coronary ostium. Abbreviations: BSA, body surface area; LCA, left coronary artery; RCA, right coronary artery.
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References

    1. Brickner M.E., Hillis L.D., Lange R.A. Congenital heart disease in adults. Second of two parts. N Engl J Med. 2000;342(5):334–342. - PubMed
    1. Haeffele C., Lui G.K. Dextro-transposition of the great arteries: long-term sequelae of atrial and arterial switch. Cardiol Clin. 2015;33(4):543–558. viii. - PubMed
    1. Jatene A.D., Fontes V.F., Paulista P.P., Souza L.C., Neger F., Galantier M., et al. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg. 1976;72(3):364–370. - PubMed
    1. Pretre R., Tamisier D., Bonhoeffer P., Mauriat P., Pouard P., Sidi D., et al. Results of the arterial switch operation in neonates with transposed great arteries. Lancet. 2001;357(9271):1826–1830. - PubMed
    1. Baumgartner H., De Backer J. The ESC clinical practice guidelines for the management of adult congenital heart disease 2020. Eur Heart J. 2020;41(43):4153–4154. - PubMed

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