Hasan SUNAR, Ahmet ŞAŞMAZEL, Ayşe YILDIRIM, Hasan ERDEM, Ayşe BAYSAL

Tüm koroner arterlerin sinüs 2’den köken aldığı büyük arter transpozisyonlu bir olguda arteriyel switch (yer değiştirme) ameliyatı

Büyük arter transpozisyonu tanısı konulan hastalarda, arteriyel switch ameliyatı sırasında koroner arterlerin implantasyonu kritik bir rol oynar. Özellikle, tüm koroner arterlerin tek sinüsten çıktığı koroner arter paternleri yüksek cerrahi risk taşıyan durumlardan birisi olup, koroner arterin implantasyonu sırasında proksimal koroner arterlerde kıvrılma ya da gerilmeye neden olabilir. Burada, tüm koroner arterlerin sinüs 2’den çıktığı büyük arter transpozisyonuna sahip olan ve arteriyel switch ameliyatı uygulanan yedi günlük bir erkek yenidoğan olgu sunuldu. Koroner arter translokasyonuna yönelik farklı teknikleri tartışıldı.

An arterial switch operation in a case with transposition of the great arteries where all coronary arteries originated from the sinus 2

The implantation of coronary arteries during an arterial switch operation plays a critical role in patients diagnosed with transposition of the great arteries. Especially, the coronary artery patterns involving the origination of all coronary arteries from a single sinus are among the conditions carrying the highest surgical risk and may cause the torsion or kinking of the proximal coronary arteries during coronary artery implantation. Herein, we presented a seven-day-old male neonate undergoing an arterial switch operation for transposition of the great arteries in which all the coronary arteries originated from the sinus 2. Different techniques for the translocation of the coronary arteries were also discussed.

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1. Jatene AD, Fontes VF, Paulista PP, Souza LC, Neger F, Galantier M, et al. Anatomic correction of transposition of the great vessels. Thorac Cardiovasc Surg 1976;72:364-70.
2. Moat NE, Pawade A, Lamb RK. Complex coronary arterial anatomy in transposition of the great arteries. Arterial switch procedure without coronary relocation. J Thorac Cardiovasc Surg 1992;103:872-6.
3. Sung SC, Chang YH, Lee HD, Kim S, Woo JS, Lee YS. Arterial switch operation for transposition of the great arteries with coronary arteries from a single aortic sinus. Ann Thorac Surg 2005;80:636-41.
4. Yamagishi M, Shuntoh K, Fujiwara K, Shinkawa T, Miyazaki T, Kitamura N. “Bay window” technique for the arterial switch operation of the transposition of the great arteries with complex coronary arteries. Ann Thorac Surg 2003;75:1769-73.
5. Massoudy P, Baltalarli A, de Leval MR, Cook A, Neudorf U, Derrick G, et al. Anatomic variability in coronary arterial distribution with regard to the arterial switch procedure. Circulation 2002;106:1980-4.
6. Yacoub MH, Radley-Smith R. Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction. Thorax 1978; 33:418-24.
7. Murthy KS, Coelho R, Kulkarni S, Ninan B, Cherian KM. Arterial switch operation with in situ coronary reallocation for transposition of great arteries with single coronary artery. Eur J Cardiothorac Surg 2004;25:246-9.
8. Martins P, Castela E. Transposition of the great arteries. Orphanet J Rare Dis 2008;3:27.
9. de Leval MR, Carthey J, Wright DJ, Farewell VT, Reason JT. Human factors and cardiac surgery: a multicenter study. J Thorac Cardiovasc Surg 2000;119:661-72.
10. Zheng JH, Xu ZW, Liu JF, Su ZK, Ding WX. Arterial switch operation with coronary arteries from a single sinus in infants. J Card Surg 2008;23:606-10.
11. Aubert J, Pannetier A, Couvelly JP, Unal D, Rouault F, Delarue A. Transposition of the great arteries. New technique for anatomical correction. Br Heart J 1978;40:204-8.
12. Takeuchi S, Katogi T. New technique for the arterial switch operation in difficult situations. Ann Thorac Surg 1990;50:1000.
13. Parry AJ, Thurm M, Hanley FL. The use of 'pericardial hoods’ for maintaining exact coronary artery geometry in the arterial switch operation with complex coronary anatomy. Eur J Cardiothorac Surg 1999;15:159-64.
14. Li J, Tulloh RM, Cook A, Schneider M, Ho SY, Anderson RH. Coronary arterial origins in transposition of the great arteries: factors that affect outcome. A morphological and clinical study. Heart 2000;83:320-5.
15. Chang YH, Sung SC, Lee HD, Kim S, Woo JS, Lee YS. Coronary reimplantation after neoaortic reconstruction can yield better result in arterial switch operation: comparison with open trap door technique. Ann Thorac Surg 2005;80:1634-40.
16. Tireli E, Korkut AK, Basaran M. Implantation of the coronary arteries after reconstruction of the neoaorta by using pericardial or pulmonary hood techniques. A significant impact on the outcome of arterial switch operations. J Cardiovasc Surg (Torino) 2003;44:173-8.
17. Wernovsky G, Mayer JE Jr, Jonas RA, Hanley FL, Blackstone EH, Kirklin JW, et al. Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 1995;109:289-301.
18. Scheule AM, Jonas RA. Management of transposition of the great arteries with single coronary artery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2001;4:34-57.
19. Pasquini L, Parness IA, Colan SD, Wernovsky G, Mayer JE, Sanders SP. Diagnosis of intramural coronary artery in transposition of the great arteries using two-dimensional echocardiography. Circulation 1993;88:1136-41.