Coronary artery anatomy in anatomically corrected malposition of the great arteries and their surgical implications
Shu-Chien Huang1, Ing-Sh Chiu, Meng-Luen Lee
1Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Insights
Coronary artery patterns in anatomically corrected malposition of the great arteries (ACM) vary and correlate with aortopulmonary rotation (APR). Understanding these variations is crucial for surgical planning in ACM patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Coronary artery (CA) anatomy in anatomically corrected malposition of the great arteries (ACM) is not well understood.
- Aortopulmonary rotation (APR) is a key feature in ACM that may influence CA patterns.
Purpose of the Study:
- To investigate the patterns of coronary artery anatomy in patients with ACM.
- To determine the association between coronary artery patterns and the degree of aortopulmonary rotation (APR) in ACM.
Main Methods:
- Analysis of CA anatomy and APR in 10 ACM patients using imaging or surgical data.
- Classification of APR based on the aortic sinus of Valsalva pattern on lateral angiograms or CT scans.
- Correlation of identified CA patterns with the degree of APR.
Main Results:
- Four distinct CA patterns were identified in the study cohort.
- A significant correlation was found between CA patterns and APR (p=0.001).
- Surgical approaches, particularly trans-annular patch techniques, are influenced by CA-APR relationships, with 90% of cases requiring modified posterior atrioventricular groove patch plasty.
Conclusions:
- Coronary artery patterns in ACM are closely correlated with aortopulmonary rotation.
- APR, as determined by aortic sinus morphology, can predict CA patterns and guide surgical strategy in ACM.
- Accurate assessment of CA anatomy and APR is essential for optimizing surgical outcomes in ACM.
Objectives:
Coronary artery (CA) anatomy of anatomically corrected malposition of the great arteries (ACM) has not been well elucidated. We studied the CA pattern and their association with the aortopulmonary rotation (APR).
Methods:
CA anatomy and APR of ACM were identified by image or surgical intervention. The degree of APR was defined by the pattern of the aortic sinus of Valsalva on the lateral angiogram or computed tomography (CT).
Results:
Four CA types were presented in 10 patients and literatures. Six patients had the same CA type as the usual pattern in transposition of the great arteries (type 1); and two had left anterior descending (LAD) from the left-hand facing sinus that also gave rise to the right CA (RCA) (type 0). One patient had LAD from the left-hand facing sinus while RCA and circumflex artery from the right-hand facing sinus (type 10); and single CA from the anterior left-hand sinus (type 3c) was identified in another. APR was left anterior in type 1 and more lateral in types 0 and 3c; and left posterior in type 10 (p=0.001). The usual pulmonary trans-annular incision can only be performed in case of type 10 CA after posterior APR (10%, 1/10). In the majority (90%, 9/10 with the CA type 1, 0, and 3c), the RCA is in front of the pulmonary annulus, and the atrioventricular groove patch plasty posterior to the RCA had to be adopted for a trans-annular patch.
Conclusions:
The observed CA pattern was correlated with APR. APR identified by the aortic sinus pattern could implicate the CA patterns and the surgical options in ACM.
