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Updated: Jan 11, 2026
Bone Marrow Sampling and Transplants
Anatomic variability in coronary arterial distribution with regard to the arterial switch procedure
Parwis Massoudy1, Ahmet Baltalarli, Marc R de Leval
1Cardiac Unit, Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.
Insights
In hearts with discordant ventriculoarterial connections, coronary artery patterns vary. Unusual great artery positions may indicate complex coronary artery origins and distribution, requiring careful surgical consideration.
Area of Science:
- Cardiovascular Anatomy
- Congenital Heart Disease
- Surgical Anatomy
Background:
- Investigated coronary arterial origins and course in hearts with discordant ventriculoarterial connections.
- Evaluated alphanumeric classifications for surgically relevant coronary artery features.
Purpose of the Study:
- To describe coronary arterial anatomy in discordant ventriculoarterial connections.
- To assess the utility of classification systems for these anatomical variations.
Main Methods:
- Studied 200 postmortem hearts.
- Noted coronary branching patterns, orifice locations, proximal course, and great artery relationships.
- Examined hearts with concordant atrioventricular and discordant ventriculoarterial connections.
Main Results:
- Identified 7 of 8 predicted sinusal origin patterns for the 3 major coronary arteries.
- Found 5 different relative positions of the great arterial trunks.
- Correlated less frequent arterial trunk relationships with unusual coronary branching and valvar commissure mismatch.
Conclusions:
- Surgically relevant coronary artery features in discordant ventriculoarterial connections are best described, not classified.
- Correlations exist between great artery relations and unusual coronary branching patterns.
- Unusual great arterial positions signal potential complexity in coronary artery anatomy for surgeons.
Background:
We investigated the coronary arterial origins and course and the position of the great arteries in hearts with discordant ventriculoarterial connections. At the same time, we sought to evaluate the practicality of alphanumeric classifications in accounting for surgically relevant features of the coronary arteries.
Methods And Results:
We studied 200 postmortem hearts, noting the patterns of coronary arterial branching, the vertical and horizontal location of the arterial orifices within the aortic sinuses, the course of the proximal coronary arteries in relation to the aortic wall, and the relations of the great arteries and their respective commissures. All hearts examined had concordant atrioventricular and discordant ventriculoarterial connections. We found 7 of the 8 predicted patterns for sinusal origin of the 3 major coronary arteries and identified 5 different positions of the arterial trunks relative to each other. A correlation was found between less frequent relationships of the arterial trunks and unusual patterns of coronary arterial branching, as well as with mismatch between the valvar commissures.
Conclusions:
The surgically relevant features of the coronary arteries in hearts with discordant ventriculoarterial connections are best described rather than classified. Correlations exist between certain, less frequent relations of the great arteries and unusual patterns of branching of the coronary arteries. The presence of unusual great arterial positions should alert the surgeon to potentially complicated arrangements of the origin and distribution of the coronary arteries.
