Late complication of intramural coronary transfer at arterial switch operation

Intra-mural coronary arteries remain a major risk factor and technical challenge of the arterial switch operation for transposition of the great arteries. We report a 27-year old woman presenting with an acute coronary syndrome late after arterial switch with a complex coronary pattern (intramural left and right coronary from sinus two). CT demonstrated that the pericardial ‘saddle bag’ used to reconstruct the intramural coronary was compressed between the neo-aortic root and neo-pulmonary trunk. At surgery, the coronary system was laid open into the neo-aorta with patch enlargement and the patient made an uneventful recovery.