Surgical Treatment of Congenital Heart Disease: How Do We Avoid Coronary-related Complications?

Abstract

The cause of perioperative coronary-related complications in congenital heart surgery is either procedure-relat- ed or an attribute of the disease itself. The representative example of the former is an arterial switch operation for the transposition of the great arteries or double outlet right ventricle. In performing safe and adequate coronary transplantation, careful observation of not only the coronary patterns but also coronary transplantation method, spatial relationship of the great arteries, and the method of pulmonary artery reconstruction are comprehensive- ly considered. In contrast, an example of the latter is pulmonary atresia with an intact ventricular septum asso- ciated with the right ventricle-coronary sinusoidal communication. To avoid perioperative coronary ischemia, special attention must be paid to intraoperative management, including the perfusion and operative methods. In addition to obtain a precise preoperative diagnosis and careful intraoperative observation, the awareness about the fact that many congenital heart diseases could have a coronary anomaly may help to avoid coronary-related complications in congenital heart surgery.