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

• Published in: International journal of cardiology congenital heart disease Vol. 14; p. 100481
• Main Authors: Verheijen, Diederick B.H., Engele, Leo J., Egorova, Anastasia D., Stöger, J. Lauran, Mertens, Bart J.A., van der Palen, Roel L.F., Koolbergen, Dave R., Hazekamp, Mark G., Jukema, J. Wouter, Vliegen, Hubert W., Bouma, Berto J., Jongbloed, Monique R.M., Kiès, Philippine
• Format: Journal Article
• Language: English
• Published: Elsevier 01.12.2023
• Subjects: Acute take-off angle; Arterial switch operation; Computed tomography angiography; Neo-aortic dilatation; Transposition of the great arteries
• ISSN: 2666-6685; 2666-6685
• DOI: 10.1016/j.ijcchd.2023.100481

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.