Late coronary complications after arterial switch operation and their treatment.

OBJECTIVES To report the late coronary complications and their treatment after arterial switch operation (ASO). BACKGROUND Asymptomatic patients after ASO may have coronary ostial stenosis or obstruction. METHODS Since 1980, 279 patients were operated with ASO. At the time of preparing this article, selective follow-up coronary angiograms were done on 81 patients. RESULTS Coronary stenosis was found in six patients. A 6-year-old patient with left coronary artery (LCA) ostial stenosis and a 9-year-old patient with conus branch occlusion had good collaterals without a need for further treatment. One patient with LCA obstruction, myocardial infarction, and left ventricular failure was operated with osteoplasty at age of 16 years. In three essentially asymptomatic patients, stenting of LCA ostium stenosis was done: in two of them with drug-eluting stents at 9 and 10 years of age and in one with bare-metal stent at 18 years of age. One of these patients was earlier treated with balloon dilatation at 5 years of age which caused intimal dissection. CONCLUSIONS Asymptomatic patients with an uneventful course after ASO may have coronary obstruction. This necessitates follow-up coronary evaluation in all patients. Stenting of the coronary arteries is an option for treatment.