Echocardiographic and Surgical Correlation of Coronary Artery Patterns in Transposition of the Great Arteries

Fundora, Michael P.; Aregullin, E. Oliver; Wernovsky, Gil; Welch, Elizabeth; Muniz, Juan-Carlos; Sasaki, Nao; Hannan, Robert L.; Burke, Redmond P.; Lopez, Leo

doi:10.1111/chd.12338

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…Transposition of the great arteries (TGA) is the one of the most common cyanotic congenital heart lesions that presents in the neonatal period [1]. Prior reports on factors affecting the outcome of the ASO demonstrated that abnormal CA patterns, such as single right, inverted coronaries and intramural course of the CA, are associated with increased risk of early mortality [2][3][4][5][6][7][8][9][10]. With the current improved surgical skills, the outcome in patients with uncommon CA pattern is similar to those with usual CA pattern [9,11,12].…”

Section: Introductionmentioning

confidence: 99%

Commissural Malalignment as a predictor of coronary artery abnormalities in patients with transposition of great arteries

Nasef

Alghamdi

Valls

et al. 2020

J Congenit Heart Dis

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Background In patients with transposition of the great arteries (TGA), commissural malalignment (CM) between semilunar valves may be associated with abnormal coronary (CA) pattern. We intend to assess the degree of CM with incidence of unusual CA anatomy. Methods We proposed a ratio to measure the distance of both ends of the anterior facing sinuses of the pulmonary valve from the facing commissure of the aortic valve. We labeled it as D1 and D2 distance. A ratio (C ratio) of the smaller distance (either D1 or D2 whichever is shorter) over the sum of both D1 and D2 was taken (D1 or D2 whichever is shorter / D1 + D2). We related this ratio with the incidence of the unusual CA anatomy in D-TGA patients. Results We had a total of 158 patients. We defined the point beyond which the C-Ratio becomes significantly associated with abnormal coronary artery pattern, this represents the median effective level (EL50). The EL50 of the C-Ratio was found to be equal to 31% (0.31). The prediction revealed that the CA pattern would most probably be usual when there is a minor commissural malalignment (C-Ratio less than the EL50) and most probably be unusual when there is a major malalignment (C-Ratio is greater than the EL50). The sensitivity was 71% and the specificity 88% (p-value < 0.0001). Conclusions The C-Ratio helps to categorize the degree of CM as minor (less than 0.31) or major (more than 0.31). A higher C-Ratio predicts a higher incidence of unusual CA pattern.

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Section: Introductionmentioning

confidence: 99%

Commissural Malalignment as a predictor of coronary artery abnormalities in patients with transposition of great arteries

Nasef

Alghamdi

Valls

et al. 2020

J Congenit Heart Dis

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“…11 Our study found a high rate of non-concordant data in coronary artery pattern different from other studies which suggested that coronary anatomy could be accurately assessed by preoperative echocardiogram (62% VS 86%). 15 This finding may be affected by retrospective design. Improvement of technology in echocardiography machine may be ameliorate this problem.…”

Section: Discussionmentioning

confidence: 97%

Impact of Accuracy of Preoperative Transthoracic Echocardiography on Complex Congenital Heart Surgery in Pediatrics

Tantiwongkosr

2019

Smj

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Objective: In simple congenital heart disease, transthoracic echocardiography for the diagnosis and preoperative evaluation is an effective investigation. But its role in complex congenital heart disease is yet to be proven. The aim of this study was to find an accuracy ratio of preoperative echocardiography in complex congenital heart disease and the effect of non-equivalent findings to surgical plan and outcomes. Methods: Medical records of complex congenital heart disease patients who underwent open heart surgery during 2013-2015, including echocardiographic reports, operative notes, in-patient and outpatient data were retrospectively reviewed. Patients who underwent palliative shunt procedure, age > 15 year and missing data were excluded. A total of 300 patients were included in the study. We used intraoperative findings as a gold standard to compare with preoperative transthoracic echocardiography. Then, we analyzed data comparing between groups of patients who had concordant and non-concordant echocardiographic finding. After that we compared between groups of patients who had surgery changed from the preoperative plan and those who had not. SPSS version 18 was used to analyze. Results: The concordance of preoperative echocardiography was 77.7%. In the non-concordant data group, approximately one third had to change the plan of operation and about one tenth had to change cannulation technique. Most of non-concordance were that of systemic venous drainage and coronary artery pattern. But it had no significant effect to surgical outcomes including operative time, cardiopulmonary bypass time, morbidity and mortality rate. Conclusion: Transthoracic echocardiography is valuable tool that give a lot of details on anatomical and physiological data in congenital heart disease. However, some complex congenital heart patients may need additional investigations such as cardiac catheterization, CT scan, Cardiac MRI in order to obtain adequate anatomical and physiological data for surgical planning.

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“…Além disso, este exame identifica detalhes anatômicos, incluindo os níveis de shunting, a relação dos grandes vasos entre si, a avaliação qualitativa da função ventricular, a presença de anomalias cardíacas congênitas adicionais e, na maioria dos pacientes, a origem das coronárias também pode ser identificada. Sendo assim, o ECO é particularmente importante nos pacientes com TGA como avaliação hemodinâmica não-invasiva da CIA, PCA, gravidade da obstrução do trato de saída arterial, função das válvulas atrioventriculares e avaliação da comunicação interventricular, caso presente (AMOOZGAR et al, 2013;FUNDORA et al, 2016;KLITSIE et al, 2014).…”

Section: Ecocardiogramaunclassified

“…É importante ressaltar que existem limitações importantes na avaliação das coronárias (COHEN et al, 2016), devido a aquisição de imagens precisas nem sempre ser possível, fatores como a anatomia torácica do paciente e a alteração posicional dos vasos causada pela manobra de Le Compte realizada na troca arterial podem interferir de maneira significativa a visibilidade. No entanto, alguns estudos apontam uma acurácia na avaliação coronariana ecocardiográfica ao redor de 86% (FUNDORA et al, 2016;KLITSIE et al, 2014).…”

Section: Ecocardiogramaunclassified

Avaliação anatômica e funcional da circulação coronariana de pacientes em pós-operatório tardio de cirurgia de Jatene

Ferreira¹

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À Deus por guiar meu caminho e me oferecer oportunidades, e também por não permitir que eu desistisse frente às dificuldades. À minha família amada e tão querida, pelo amparo e amor que me concederam em todos os momentos da minha vida. Aos meus pais por confiarem em mim e nunca deixarem que eu desistisse. Em especial a minha irmã amada, peça fundamental neste trabalho, que sem ela não teria conseguido chegar aqui. Ao meu companheiro Tobias, pela paciência e amparo durante todo este processo, me tolerando nos momentos difíceis e nas minhas ausências. Ao meu orientador Prof. Dr. Paulo Henrique Manso, por ter me concedido a oportunidade e pela confiança depositada em mim. Agradeço por todo o apoio, orientação, paciência, tempo dispendido e enorme contribuição para o meu crescimento pessoal, científico e intelectual. Ao Dr. Tarcísio, pela amizade, pelos ensinamentos e disponibilidade para auxiliar em todos os momentos do estudo, em especial, nas coletas. Obrigada pela confiança depositada em mim! Ao Dr. Julio, pelo auxílio incondicional e fundamental durante os testes cardiopulmares, pois sem ele não teria conseguido realizar os testes. Ao Prof. Dr. Gallo e Dr. Pedro pela ajuda e pela disponibilização do laboratório de ergoespirometria. À Dra. Maria Fernanda, por me auxiliar nas coletas, pela amizade e carinho. Aos residentes de cardiologia (Lucas, Paula, Henrique, Monique e Kelly) por me auxiliarem no recrutamento dos pacientes. À divisão de Radiologia da Unidade de Emergências do HCFMRP-USP, em especial ao Dr. Leonardo, Dr. Henrique e a enfermeira Juliana, pela ajuda e disponibilidade em me ajudar a conduzir as angiotomografias. Aos pacientes e seus familiares, pela sua imprescindível colaboração e participação. "Senhor, fazei-me instrumento de vossa paz. Onde houver ódio, que eu leve o amor; Onde houver ofensa, que eu leve o perdão; Onde houver discórdia, que eu leve a união; Onde houver dúvida, que eu leve a fé; Onde houver erro, que eu leve a verdade; Onde houver desespero, que eu leve a esperança; Onde houver tristeza, que eu leve a alegria; Onde houver trevas, que eu leve a luz. Ó Mestre, Fazei que eu procure mais Consolar, que ser consolado; compreender, que ser compreendido; amar, que ser amado. Pois é dando que se recebe, é perdoando que se é perdoado, e é morrendo que se vive para a vida eterna."

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Echocardiographic and Surgical Correlation of Coronary Artery Patterns in Transposition of the Great Arteries

Cited by 8 publications

References 18 publications

Commissural Malalignment as a predictor of coronary artery abnormalities in patients with transposition of great arteries

Commissural Malalignment as a predictor of coronary artery abnormalities in patients with transposition of great arteries

Impact of Accuracy of Preoperative Transthoracic Echocardiography on Complex Congenital Heart Surgery in Pediatrics

Avaliação anatômica e funcional da circulação coronariana de pacientes em pós-operatório tardio de cirurgia de Jatene

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