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DOI: 10.1055/s-0036-1571828
Anatomical Classifications of the Coronary Arteries in Complete Transposition of the Great Arteries and Double Outlet Right Ventricle with Subpulmonary Ventricular Septal Defect
Publication History
10 September 2015
18 December 2015
Publication Date:
02 March 2016 (online)
![](https://www.thieme-connect.de/media/thoracic/201701/lookinside/thumbnails/10-1055-s-0036-1571828_154290oc-1.jpg)
Abstract
Objective To discuss the anatomical morphologies of the coronary arteries and frequencies of unusual coronary arteries in complete transposition of the great arteries and double outlet right ventricle (DORV) associated with a subpulmonic ventricular septal defect (VSD).
Methods Between March 1999 and August 2012, 1,078 patients with complete transposition of the great arteries or DORV with subpulmonary VSD underwent arterial switch operations (ASOs) and were visually evaluated to classify their coronary artery morphology during open heart surgery.
Results The coronary arteries could be classified into five patterns with several subtypes. Unusual coronary arteries were observed in 248 of the 1,078 cases, providing a frequency of 23.01%. The frequencies of the patients with transposition of the great arteries with intact ventricular septum (TGA/IVS), TGA/VSD, and DORV with subpulmonary VSD were 17.65, 23.28, and 31.84%, respectively. The most common morphologies were the right coronary artery (RCA) originating from sinus 1 and circumflex (CX) originating from sinus 2 (1R, AD; 2CX; 26.50%); the CX originating from sinus 2 (1AD; 2R, CX; 21.36%); the RCA, left anterior descending artery, and CX originating from single sinus 2 (2R, AD, CX; 13.24%). The in-hospital mortalities of the patients with or without unusual coronary arteries after ASO were 14.1 and 6.02%, respectively.
Conclusion Patients with complete transposition of the great arteries or DORV with subpulmonary VSD have a high frequency of unusual coronary arteries, which might greatly impact on the mortality for ASO. Improving the preoperative diagnostic criteria for coronary artery morphology may significantly increase the success rate for ASOs.
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References
- 1 Neches WH, Park SC, Ettedgui JA. Transposition of the great arteries. In: Garson JR, Bricker JT, Fisher DJ, Neish SR, eds. The Science and Practice of Pediatric Cardiology. 2nd ed. Baltimore, MD: Williams & Wikins; 1998: 1463-1503
- 2 Castaneda AR, Jonas RA, Mayer JE. Cardiac Surgery of the Neonate and Infant. 1st ed. Philadelphia, PA: Saunders; 1994: 410-411
- 3 Castaneda AR, Norwood WI, Jonas RA, Colon SD, Sanders SP, Lang P. Transposition of the great arteries and intact ventricular septum: anatomical repair in the neonate. Ann Thorac Surg 1984; 38 (5) 438-443
- 4 Van Praagh R. What is the Taussig-Bing malformation?. Circulation 1968; 38 (3) 445-449
- 5 Jatene AD, Fontes VF, Paulista PP , et al. Successful anatomic correction of transposition of the great vessels. A preliminary report. Arq Bras Cardiol 1975; 28 (4) 461-464
- 6 Shaher RM, Puddu GC. Coronary arterial anatomy in complete transposition of the great vessels. Am J Cardiol 1966; 17 (3) 355-361
- 7 Yacoub MH, Radley-Smith R. Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction. Thorax 1978; 33 (4) 418-424
- 8 Gittenberger-de Groot AC, Sauer U, Oppenkeimer-Dekker A, Quaegebeur J. Coronary arterial anatomy in transposition of great arteries: a morphological study. Pediatr Cardiol 1983; 4 (Suppl. 01) 15-24
- 9 Van Praagh R, Jung WK. The arterial switch operation in transposition of the great arteries: anatomic indications and contraindications. Thorac Cardiovasc Surg 1991; 39 (Suppl. 02) 138-150
- 10 Rowlatt UF. Coronary artery distribution in complete transposition. JAMA 1962; 179 (2) 269-278
- 11 Chiu CSW, Lee J, Leung MP. Arterial switch operation for transposition of great vessels — experience in Hong Kong. Hong Kong J Pediatr 1994; 11 (1) 33-40
- 12 Prêtre R, Tamisier D, Bonhoeffer P , et al. Results of the arterial switch operation in neonates with transposed great arteries. Lancet 2001; 357 (9271): 1826-1830
- 13 Lalezari S, Bruggemans EF, Blom NA, Hazekamp MG. Thirty-year experience with the arterial switch operation. Ann Thorac Surg 2011; 92 (3) 973-979
- 14 Jonas RA, DiNardo J, Laussen PC, Howe R, LaPierre R, Matte G. Comprehensive Surgical Management of Congenital Heart Disease. 1st ed. London: Oxford University Press; 2004: 263-276