Published online Aug 16, 2016. doi: 10.12998/wjcc.v4.i8.219
Peer-review started: February 23, 2016
First decision: March 25, 2016
Revised: March 31, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: August 16, 2016
Core tip: In complete transposition of the great arteries (TGA), neonatal arterial switch operation offers excellent long term survival. Yet there can be late coronary artery complications. In this case, an asymptomatic teenager had an abnormal screening exercise-stress test leading to the identification of complete left coronary occlusion. This case illustrates how rich coronary collateralization can obscure even complete coronary occlusion. As such, young patients pose a unique diagnostic challenge. Coronary computed tomogram (CT) angiogram and conventional angiography were the best imaging modalities to detect the problem. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies.