1. Coronary Lesions after ASO in patients with TGA-IVS/VSD
Coronary Lesions after ASO in patients with TGA-IVS/VSD. Do we need an interventional Follow up in Asymptomatic Patients?

2. Introduction
Arterial Switch Operation is the procedure of choice for TGA last ten years
Literature reports of Long term Complications:
Pulmonary artery or PA stenosis (7-40%)
Neo-aortic Root Dilatation and/or Neo-aortic Valve Regurgitation (1-5%)
Coronary Artery Lesions (3-8%)
Silent coronary obstructive lesions : 6-8%

3. Coronary Lesions Literature (i)
387 patients from in one center in Japan
Mean follow up 10 years
Selective coronary angiography in 210 patients (54.3%) at 9.6 years after ASO.
Two patients had left main tract occlusion (1.0%, 2/210) and 10 patients had hypoplastic left coronary artery (4.8%, 10/210). The 8 of them has no clinical evidence of ischaemia
Shinichiro Oda, Toshihide Nakano, Junya Sugiura, Naoki Fusazaki, Shiro Ishikawa, Hideaki Kado; Twenty-eight years' experience of arterial switch operation for transposition of the great arteries in a single institution, European Journal of Cardio-Thoracic Surgery, Volume 42, Issue 4, 1 October 2012, Pages 674–679,

4. Coronary Lesions Literature (ii)
:182 patients in Mayo Clinic with ASO for TGA
3 from 32 reoperations was for Coronary lesions
Suggest coronary CT or angiography 5 years after ASO in TGA with Complex coronary anatomy
Raju V., Burkhart H.M., Durham III L.A., Eidem B.W., Phillips S.D., Li Z., Schaff H.V., DearaniJ.A. Reoperation after arterial switch: A 27-Year experience (2013) Annals of Thoracic Surgery,  95  (6) , pp.  ,

5. Follow up Guidelines Literature(iii)
Sarris, G., Balmer, C., Bonou, P., Comas, J., Da Cruz, E., Di Chiara, L., Vouhé, P. (2017). Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum: The Task Force on Transposition of the Great Arteries of the European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC). Cardiology in the Young, 27(3),

6. Study Protocol-Aim Multi-institutional Study from ECHSA centers
Collect and analyze information from each participating center regarding the follow up of ASO survivors regarding the protocol used in detecting possible “silent” ischemia and incidence of ischemia events or sudden deaths and the results of such a follow up.

7. Study Protocol-Aim Aims: Collect and analyze information on
Incidence of symptoms of ischemia and/or Myocardial Infarction/Sudden Death
Detection of “silent” ischemia
Protocols for follow up
Incidence
Treatment

8. Study Protocol-Inclusion/Exclusion Criteria
Inclusion Criteria: All ASO survivors for TGA with or without history of ischemia the last 30 years who have recent (less than 2 years) follow up, which included any method of assesment of coronary stenosis or ischemia:
Scintigraphy
CT angiography
ETT
Standard angiography
Stress echo
Exclusion Criteria: TGA-VSD-LVOTO
ccTGA

9. Study Protocol-Method
Method : Data about follow up, demographic, anatomic and post-ASO status, as reoperation rate for coronary lesion, sudden death incidence, symptoms of ischemia and clinical/laboratory evidence of ”silent” ischemia will be collected as to the attached excel sheet.