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To investigate the influence of coronary artery variation on the outcome of arterial switch operation for transposition of great arteries.Among 280 patients undergoing arterial switch operations at our hospital from 2001 to 2008, 73 (26.1%) had concurrent coronary arteries variation (54 males and 19 females; median age: 0.6 ± 1.1 years old; mean body weight: 5.8 ± 2.6 kg). Of these 73 patients (variant group), 21 cases had transposition of great arteries with a ventricular septal defect and 30 cases with an intact ventricular septum. The other 22 cases were of Taussig-Bing anomalies. Another 207 cases had usual coronary arteries (usual group). Coronary artery transfer was achieved by implantation of buttons to the previously anastomosed neo-aorta.There were 29 early death (10.4%) including 12 cases (16.4%) in variant group and 17 cases (8.21%) in usual group (P0.05). Mean cardiopulmonary bypass and cross-clamp durations were 229 ± 84 and 146 ± 48 min in variant group while 206 ± 59 and 137 ± 40 min in usual group (P0.05). Six cases were confirmed intra-operatively as coronary compression or obstruction. Complications included infection (n = 11), low output syndrome (n = 7), diaphragm paralysis (n = 3), pericardial effusion (n = 2) and atrioventricular block (n = 2).Coronary artery variation increases the operative difficulty and influences the outcome. The operative proficiency may decrease the mortality.

To explore the clinical experiences of combined palliative procedures for cyanotic congenital heart defects with intractable hypoplasia of pulmonary arteries.From August 2001 to September 2009, 31 patients with cyanotic congenital heart defects and intractable hypoplasia of pulmonary arteries underwent surgical procedures. Among them, 26 patients were pulmonary atresia with ventricular septal defect and the other 5 cases complicated congenital heart defects with pulmonary stenosis. Different kinds of palliative procedures were performed according to the morphology of right and left pulmonary arteries in every patient. If the pulmonary artery was well developed, Glenn procedure was performed. Modified Blalock-Taussig or Waterston shunt was performed if pulmonary arteries had hypoplasia. If the pulmonary arteries were of severe hypoplasia, Melbourne shunt was performed. Systemic-pulmonary artery shunts were performed bilaterally in 23 cases. Systemic-pulmonary shunt was performed in one side and Glenn procedure contralaterally in 8 cases.There was one early death because of cardiac arrest. The number of patients suffered from low cardiac output syndrome, perfusion lung and pulmonary infection postoperatively was 5, 3 and 2, respectively. Systemic-pulmonary shunts were reperformed after the original operation in 3 cases because of occlusion of conduits. The mean follow-up time was 25 ± 16 months (6 - 72 months). Left pulmonary index (8.1 ± 3.7 vs 14.9 ± 6.2), right pulmonary index (12.7 ± 8.1 vs 17.7 ± 7.8) and pulmonary index (20.9 ± 9.4 vs 32.6 ± 11.7) increased significantly (all P0.001). The pulmonary diameter increased significantly after modified Blalock-Taussig shunt (5.5 ± 1.0 vs 7.0 ± 2.0), modified Waterston shunt (5.7 ± 4.0 vs 9.2 ± 3.6) and melbourne shunt (2.2 ± 0.4 vs 7.4 ± 2.5) (all P0.05). Bilateral pulmonary arteries developed well compared with that of preoperative condition. Hemoglobin decreased from (194 ± 27) g/L to (174 ± 24) g/L (P0.05) and peripheral oxygen saturation increased from (65 ± 11)% to (84 ± 6)% (P0.001). During the follow-up ultimate complete repair were performed in 3 cases and one patients underwent Glenn procedure.The procedures should be considered for hypoplasia of pulmonary arteries in cyanotic congenital heart defects. Combined palliative operation is an adequate therapy.