Comment
The single coronary may present technical challenges during arterial switch operation with both early and longterm implications. (1) The transfer of a single coronary artery from non facing sinus in Taussig-Bing anomaly with side by side relationship of great arteries can indeed be difficult. The distance from the non-facing sinus to neo-aorta can be significant enough to preclude direct transfer. The mobilisation of a single coronary artery is further limited by early branching. Atrial switch or Damus-kaye-stansel (DKS) with Rastelli can be considered when traditional arterial switch operation (ASO) can not be performed. (2) However, atrial switch commits right ventricle for systemic circulation and is bound to have poor longterm prognosis. DKS with Rastelli is an innovative technique but the child is committed to multiple operations for the right ventricle outflow tract (RVOT). Therefore, pursuing ASO may still be the best option. Some of the techniques described to facilitate ASO with “difficult to transfer” coronary patterns are in situ coronary relocation, trap door with pericardial hood and coronary extension using aortic autograft. (3,4,5) Though, aortic autograft concept has an advantage of growth potential, it may not always be feasible to obtain enough aortic tissue to create a tube of desired length. The in situ coronary translocation is not feasible if the coronary artery arises from the non-facing sinus. In such circumstances, autologous pericardial tube which is viable, non-allogenic, pliable, haemostatic and readily available is an acceptable alternative. Animal studies have demonstrated that autologous pericardium has better fibrinolytic activity and less sub-endothelial fibrosis which will translate into less thrombogenicity and contracture. (6) Though, the pericardial tube as coronary extension has remained patent for more than two years, the longterm outcome is yet to be seen and a cautious follow-up is recommended.