Background and aims The arterial switch operation (ASO) is the surgical standard of care for repair of transposition of the great arteries (D-TGA). Until recently, anatomical variations of the coronary arteries, especially the intramural course of a single coronary artery, were considered contraindications for ASO. Transfer of the coronary arteries may be a surgical challenge in these cases increasing the risk of (sub-)acute coronary artery occlusions.
Methods We report our management of two exemplary cases of D-TGA with coronary artery anomalies:
(1) Single coronary ostium of RCA, Cx and LAD originating from aortic sinus II and an intramural course of the proximal LAD.
(2) Side-by-side position of the great arteries, RCA and LAD originating from sinus I and Cx from sinus II.
Results Both neonates successfully underwent ASO with transfer of the coronary arteries.
During the post-operative period, patient 1 was diagnosed with a subacute anteroseptal ischemia and was then managed conservatively. Follow-up echocardiogram at 12 months demonstrated satisfactory left and good right ventricular function.
The postsurgical course of patient 2 was uneventful with good biventricular function at follow-up.
Conclusions Anatomical variations of the coronary arteries require adaptions of the surgical technique of coronary artery transfer. Nowadays, ASO is even possible in patients with D-TGA and complex coronary anomalies. The long-term management, however, has to be evaluated, e.g. regarding the need for coronary artery re-surgery.