See Section 3.3 for recommendations on who should perform surgeries, cardiac catheterization, and other procedures in these patients; Section 3.4 for rec- ommendations on diagnostic evaluation; and Table 30 for routine testing and follow-up intervals. Recommendation-Specific Supportive Text 1. Imaging in patients after arterial switch should be performed with specific sequelae in mind, including PS (recognizing the Lecompte maneuver has been used during surgery in most), and neoaortic root and valve problems. Some patients with early ar- terial switch repairs had right ventricle to-PA con- duits placed and may have related complications. CLINICAL STATEMENTS AND GUIDELINES 2. Because of nuances of the arterial switch, deci- sions regarding coronary intervention should be considered jointly by ACHD providers and those with expertise in coronary revascularization tech- niques. Abnormalities commonly occur proximally and close to the anteriorly positioned coronary buttons. Coronary buttons are usually located posterior to the main PA after the Lecompte ma- neuver. Revascularization techniques may include revision of the coronary buttons, ostioplasty, in- terposition grafts, or coronary bypass grafting. 3. There is evidence that coronary abnormalities are common after arterial switch (6% to 10%), es- pecially in the setting of coronary anomalies at birth, or extensive manipulation of the coronaries at the time of the operation. However, most cor- onary problems and events described so far tend to occur in childhood in the first few years after surgery, with limited experience in adults,S4.4.1.2-1, although the prevalence of coronary issues may increase as the popula- tion ages. Physiological testing lacks sensitivity. 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. 