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Abnormal Coronary Anatomy in Patients with Transposition of the Great Arteries and Atrial Switch: A Predictor of Serious Cardiac Adverse Events?

Yoann Perreux1, Marie Alexandre Chaix2, Anna Kamp3, François-Pierre Mongeon2, Magali Pham2, Loïc Boussel1, Roland Henaine1, Annie Dore2, Blandine Mondésert2, Sylvie Di-Filippo1, Paul Khairy2, Francis Bessiere1,*

1 Hôpital Cardiologique Louis Pradel, 59 boulevard Pinel, 69500, Bron, Hospices Civils de Lyon, Lyon, France
2 Montreal Heart Institute, Montreal, H1T 1C8, Canada
3 Nationwide Children’s Hospital, Columbus, OH 43205, USA

* Corresponding Author: Francis Bessiere. Email: email

Congenital Heart Disease 2020, 15(6), 473-482.


Sudden cardiac death and heart failure are well known long-term complications after atrial switch for D-transposition of the great arteries (D-TGA). Right systemic ventricular dysfunction is common and myocardial ischemia has been implicated as a putative mechanism for sudden death, with coronary anomalies prevalent in 30% of cases. We sought to assess an association between adverse events and coronary anomalies in patients with D-TGA and atrial switch surgery. An observational study was conducted in 3 tertiary centers (Montreal Heart Institute, Canada, Nationwide Children’s hospital, Chicago, USA and Hopital cardiologique Louis Pradel de Lyon, France). Adults with D-TGA and atrial switch surgery qualified for inclusion if they had a major adverse cardiovascular event (MACE), i.e., ventricular arrhythmia, sudden cardiac death, heart failure, cardiac transplantation, or cardiovascular death. The prevalence of coronary anomalies was compared to historical controls. Forty-five patients were included. Twenty-one (46.7%) patients experienced a ventricular arrhythmia and 35 (77.8%) suffered from symptomatic heart failure and/or severe right ventricular dysfunction. Twelve patients (26.7%) had congenitally abnormal coronary arteries. There was no difference in the prevalence of coronary anomalies between the cohort with a MACE and a pooled population of 647 historical controls with D-TGA (28.7%, p = 0.89). In conclusion, the prevalence of congenital coronary anomalies is not higher in patients with D-TGA and atrial switch surgery who had adverse cardiovascular events. It could be hypothesized that ischemic complications in this patient population are more likely to be related to a supply-demand mismatch of the distal microvasculature rather than proximal coronary anomalies.


Cite This Article

Perreux, Y., Chaix, M. A., Kamp, A., Mongeon, F., Pham, M. et al. (2020). Abnormal Coronary Anatomy in Patients with Transposition of the Great Arteries and Atrial Switch: A Predictor of Serious Cardiac Adverse Events?. Congenital Heart Disease, 15(6), 473–482.

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