Therefore, a benchmark assessment of the ana- tomic course and patency of the coronary arter- ies (ie, catheter angiography or CT angiography) is prudent in adults in whom this information has not already been obtained. MR coronary angiography may also be an option for evaluat- ing coronary patency.S4.4.1.2-9 Thereafter, coro- nary investigations will be prompted largely by symptoms. 4. Once the coronary anatomy in an arterial switch recipient is documented, there is little justifica- tion for serial anatomic imaging in an asympto- matic individual. Symptomatic patients should be offered stress physiological imaging and repeat anatomic imaging considered if symptoms are suggestive of coronary ischemia.S4.4.1.2-8 5. Decisions about the indications and approach for coronary intervention after an arterial switch can be guided according to management rec- ommendations for care of atherosclerotic cor- onary disease, emphasizing prudent medical therapy and a symptom-guided approach to The unique aspects of the anatomic abnormalities and unusual course of the proximal coronary arteries must be kept in mind, mandating collaboration between ACHD providers and those with the necessary surgical or interventional expertise. 6. Although some degree of neoaortic valve regurgi- tation is common, surgery to replace the neoaor- tic valve has only rarely been reported. Indications for valve replacement should be based on LV size and/or symptoms according to the 2014 VHD The more common concern is dilation of the neoaortic root with preserved aortic valve competence. Valve-sparing root re- placement is often considered in such cases, but surgical options should be individualized based upon anatomy and changes over time. There are not data to support a specific aortic diam- eter beyond which the risk of dissection or rup- ture increases sufficiently to warrant prophylactic aortic replacement. 7. 