Arterial Switch Operation - Late Complications — EECC MCQ

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ModerateCongenital Heart Disease (Adult)Arterial Switch Operation - Late ComplicationsEECC

A 25-year-old woman who underwent an arterial switch operation (ASO) for D-transposition of the great arteries (D-TGA) as a neonate is seen in the ACHD clinic. What is the most important long-term cardiac complication to monitor for?

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Correct answer: D — Coronary artery ostial stenosis or kinking from the coronary reimplantation during the original surgery

The arterial switch operation (ASO) involves transecting both great arteries, switching them to the correct ventricle, and reimplanting the coronary arteries into the neo-aorta. While ASO provides excellent long-term outcomes (normal LV as systemic ventricle), the most important late complication is coronary artery abnormalities related to the coronary reimplantation: ostial stenosis, kinking, or stretching. These can cause myocardial ischaemia and sudden death, particularly during exercise. Other late complications include neo-aortic root dilatation and neo-aortic regurgitation, and supravalvar pulmonary stenosis at the anastomosis site. Systemic RV failure and baffle issues are complications of the atrial switch (Mustard/Senning), not the arterial switch.

Reference: ESC (2020): Guidelines for the Management of Adult Congenital Heart Disease