Next imaging study. The arterial switch operation (ASO) has superseded the Mustard and Senning procedures as the most common surgery performed in D-TGA. In the ASO (Jatene procedure), the ascending aorta and the main pulmonary artery are transected above their valve leaflets and moved to their correct circulatory position (Lecompte maneuver). The coronary arteries are then transplanted from the native aortic root to the neoaortic root (which is the native pulmonary trunk). Septal defects, if present, are surgically closed. Well-known sequelae after an ASO include obstruction of the coronary arteries with related myocardial ischemia, LV dysfunction, narrowing of the pulmonary artery side branches, RVOT obstruction, neoaortic valve insufficiency, and dilatation of the aortic root. RVOT and pulmonary artery stenoses may lead to RV dysfunction necessitating corrective procedures. Supravalvular pulmonary stenosis, particularly in the side branches of the pulmonary arteries, occurs early after an ASO. Dilatation and insufficiency of the neoaortic root usually develops over time. Coronary abnormalities can be present in 8% of asymptomatic individuals on 1- to 20-year follow-up and, although uncommon, can cause sudden death [23]. Noninvasive imaging of the postoperative anatomy is integral to the Congenital or Acquired Heart Disease management of patients who have undergone an ASO. A combination of imaging tests and exercise testing are performed to screen for complications and to assess severity and the need for intervention and the type of intervention. Arteriography Coronary with Ventriculography The coronary artery course has a particularly high variability in patients with TGA. After an ASO, many patients require repeated imaging of their reimplanted coronary arteries. Cardiac catheterization and ventriculography after ASO is reserved for only complex cases in whom incremental information is needed following advanced imaging.
Congenital or Acquired Heart Disease. Next imaging study. The arterial switch operation (ASO) has superseded the Mustard and Senning procedures as the most common surgery performed in D-TGA. In the ASO (Jatene procedure), the ascending aorta and the main pulmonary artery are transected above their valve leaflets and moved to their correct circulatory position (Lecompte maneuver). The coronary arteries are then transplanted from the native aortic root to the neoaortic root (which is the native pulmonary trunk). Septal defects, if present, are surgically closed. Well-known sequelae after an ASO include obstruction of the coronary arteries with related myocardial ischemia, LV dysfunction, narrowing of the pulmonary artery side branches, RVOT obstruction, neoaortic valve insufficiency, and dilatation of the aortic root. RVOT and pulmonary artery stenoses may lead to RV dysfunction necessitating corrective procedures. Supravalvular pulmonary stenosis, particularly in the side branches of the pulmonary arteries, occurs early after an ASO. Dilatation and insufficiency of the neoaortic root usually develops over time. Coronary abnormalities can be present in 8% of asymptomatic individuals on 1- to 20-year follow-up and, although uncommon, can cause sudden death [23]. Noninvasive imaging of the postoperative anatomy is integral to the Congenital or Acquired Heart Disease management of patients who have undergone an ASO. A combination of imaging tests and exercise testing are performed to screen for complications and to assess severity and the need for intervention and the type of intervention. Arteriography Coronary with Ventriculography The coronary artery course has a particularly high variability in patients with TGA. After an ASO, many patients require repeated imaging of their reimplanted coronary arteries. Cardiac catheterization and ventriculography after ASO is reserved for only complex cases in whom incremental information is needed following advanced imaging.