Clinical Implications of Short-Axis Aortopulmonary Rotation on Juxtacommissural Origin of the Coronary Artery in Transposition of the Great Arteries and Surgical Strategy

Abstract

JOCA in TGA was related to short axis APR, generally near FC in anterior TGA (except types 5cj and 9j), and near the RNC in posterior TGA. A superior (lateral) or medial flap, to augment the coronary button for JOCA near FC or RNC is helpful for a successful ASO.

Understanding coronary arterial anatomy in the congenitally malformed heart

“…These include the notions of dual as opposed to single sinus entry to the aortic root, 22 and intramural origin of the coronary arteries. 31 It is our belief that, in time, the notion of marriage of convenience will underscore an all-embracing categorisation for the disposition of the coronary arteries in the congenitally malformed heart. To prove successful, however, such an advance will require uniform description of the location of the aortic root within the cardiac base.…”

“…The concept provides insights into additional features that we have been unable to discuss because of the constraints of space. These include the notions of dual as opposed to single sinus entry to the aortic root, 22 and intramural origin of the coronary arteries 31 . It is our belief that, in time, the notion of marriage of convenience will underscore an all-embracing categorisation for the disposition of the coronary arteries in the congenitally malformed heart.…”

Restoration of Transposed Great Arteries With or Without Subpulmonary Obstruction to Nature

“…We found that the pattern of the CA is dependent on aortopulmonary rotation, thus proposed a new categorization scheme based on the aortic root rotation (Chiu et al, 1995). In addition to the short-axis rotation, which is related to the juxtacommissural origin of the CA (JOCA) (Chiu et al, 1997), there is also a long-axis rotation, which is related to high takeoff of the CA (Chiu et al, 1996b). On the basis of these findings, we have also proposed appropriate diagnostic and surgical techniques to manage unusual CA patterns in TGA (Chiu et al, 1997;Chiu et al, 1996a).…”

“…In addition to the short-axis rotation, which is related to the juxtacommissural origin of the CA (JOCA) (Chiu et al, 1997), there is also a long-axis rotation, which is related to high takeoff of the CA (Chiu et al, 1996b). On the basis of these findings, we have also proposed appropriate diagnostic and surgical techniques to manage unusual CA patterns in TGA (Chiu et al, 1997;Chiu et al, 1996a). In short, for JOCA near the facing commissure, a superiorly based trapdoor (single-button technique) or lateral funnel (two-button technique), and near the nonfacing commissure, a medially based trapdoor, are vital for coronary redirection.…”

“…The distal MPA (blue clay) could be reattached to the old MPA stump (red clay), at the neoaortic anastomosis site (blue/red junction marked with @) or proximal to it on the posterior wall of old MPA stump (marked with an asterisk), or remain undivided (in that case blue/red junction indicated site of neoaortic anastomosis); thus, the troublesome posterior neoaortic No-fault transfer of the coronary artery is the cornerstone of a successful ASO. Various techniques (Aubert et al, 1978;Yacoub and Randly Smith, 1978;Kurosawa et al, 1986;Quaegebeur et al, 1986;Brawn and Mee, 1988;Idriss et al, 1988;Bove et al, 1989;Takeuchi and Katogi, 1990;Mee, 1994;de Leval et al, 1994;Murthy & Cherian, 1996;Chiu et al, 1996aChiu et al, & 1997 have been proposed to achieve this goal: de Leval et al (1994) pointed out that the key point is to take the aorta away from the coronary arteries and the MPA is brought to them, rather than moving the coronaries from the aorta and transferring the coronary scallops to the MPA or neoaorta. To implement this concept, in situ transfer technique, proposed by Aubert et al (1978) and Takeuchi and Katogi (1990), was developed by Murthy and Cherian (1996).…”