Arterial switch operation: A surgical triumph with long-term management challenges

Since the late 1980s, the standard approach for treating D-transposition of the great arteries has been the arterial switch operation (ASO), replacing the Mustard/Senning procedure. Although ASO has shown impressive long-term survival rates, recent case series have revealed late complications such as neoaortic dilation and coronary artery stenosis. New findings emphasize the need for comprehensive evaluation of coronary risk and a deeper understanding of the mechanisms leading to coronary artery stenosis and myocardial ischemia over the long term. Computed tomography angiography (CTA) has unveiled a notable prevalence of abnormal coronary arteries with potential risk of stenosis and myocardial ischemia. Moreover, the progressive dilation of the neoaortic root and the potential for valve regurgitation necessitating intervention warrant serial imaging follow-up. Considering the radiation risks associated with CTA, magnetic resonance imaging emerges as a preferred modality for post-ASO patient assessment. Ongoing research in this field holds the promise of developing improved diagnostic and therapeutic strategies for these patients, thereby enhancing their long-term care