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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 706-712, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RW Day, H Laks and DC Drinkwater
To determine whether coronary anatomy influences the outcome of the
neonatal arterial switch operation, we examined the results in all newborn
infants (n = 70) with D-transposition of the great arteries who had a
corrective operation at our institution between March 1987 and April 1991.
The origin and distribution of coronary arteries were identified
preoperatively by echocardiography, aortic root angiography, or selective
coronary arteriography and intraoperatively by direct inspection. However,
the arterial switch operation was performed independent of the coronary
anatomy in all but two candidates for the operation. Four early deaths
occurred and five surviving patients had symptoms of impaired cardiac
function. No late deaths have occurred in patients followed up for 2 to 50
months. Evidence of myocardial ischemia was present in three of the four
deaths and in four of the five patients with cardiovascular symptoms.
Patients with commissural or intramural coronary origins between the great
arteries had significantly greater cardiovascular morbidity and mortality
because of coronary ischemia than patients with the most common coronary
pattern. Thus coronary anatomy may influence surgical management and the
postoperative course of newborn infants with transposition.
ARTICLES
The influence of coronary anatomy on the arterial switch operation in neonates
Division of Pediatric Cardiology, University of California, Los Angeles School of Medicine 90024.
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