Anatomical Classifications of the Coronary Arteries in Complete Transposition of the Great Arteries and Double Outlet Right Ventricle with Subpulmonary Ventricular Septal Defect

Abstract

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). 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. 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. 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.

Numerical Simulation of the Influence of Geometric Configurations on Pressure Difference in the Intraventricular Tunnel

“…By combining cardiac CT angiography with 3D printing technology, scholars can accurately determine the pathological classification of DORV before surgery. Pathological heart model analysis and simulated surgery can significantly reduce the intraoperative exploration time of DORV with VSD far from the two main arteries (Lefort et al, 2001;Meduri et al, 2007;Garekar et al, 2016;Pang et al, 2017;Wang et al, 2017;Mostefa-Kara et al, 2018).…”

Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography

“…Patients who have TGA and a VSD are more likely to have an unusual CA pattern compared to patients with TGA and an intact ventricular septum. 136 It is important to make a preoperative diagnosis of an intramural CA pattern ( Figure 22G and H), which occurs when one of the CAs is inverted but courses between the aorta and the PA rather than anterior or posterior to these vessels. The interarterial course makes it likely that the CA is also intramural.…”

Narrative review of assessing the surgical options for double outlet right ventricle

“…Narrative review of assessing the surgical options for double outlet right ventricle of studies has now been published on both the morphology and categorization (5)(6)(7)(8)(9)(10)(11)(12)(13)(14), as well as the available surgical approaches . In this regard, the recent advances in high resolution cross-sectional imaging, along with threedimensional anatomical reconstruction and printing, have also generated a series of articles highlighting their usefulness in planning the surgical approach for the repair (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50).…”