Single coronary artery and complete transposition of the great arteries: a technical challenge resolved?

Background. The origin of the coronary arteries from a single aortic sinus remains a rare congenital anomaly, once regarded as having little clinical significance. Contemporary surgical practice, however, frequently demands precise coronary reimplantation. In this article we emphasize a prophylactic surgical technique found especially helpful in the repair of d-transposition of the great arteries (d-TGA)/single coronary artery. Methods. We reviewed the institutional cardiac registry. Results. Since 1985, 398 neonates with d-TGA were repaired with the arterial switch procedure. A mortality rate of 38% was encountered in “simple” d-TGA (n = 174)/single coronary (2.9% left facing sinus (IRLCx), 7.5% right facing sinus (IIRLCx)) and 41% in neonates with d-TGA (n = 224)/single coronary (3.6% IRLCx, 12% IIRLCx). During the past 3.5 years the surgical mortality rate of neonates (n = 6) treated with origin of the coronary arteries from a single aortic sinus has dropped to 0%. Conclusions. The surgical repair of d-TGA/single coronary artery continues to trouble surgeons. The implantation of a well-mobilized coronary “button” into a previously anastomosed neoaorta remains a key prophylactic technique in the achievement of good technical results.