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Coronary artery diameters in the heart with complete transposition of the great vessels
R M Oberhoffer1, S Y Ho, R H Anderson
1University of Ulm, Paediatric Clinics, Federal Republic of Germany.
Insights
Coronary artery dimensions in complete transposition of the great arteries are comparable to normal hearts, showing consistent growth with patient size. Further study is needed for post-arterial switch procedure cases.
Area of Science:
- Cardiovascular Medicine
- Pediatric Cardiology
- Anatomical Pathology
Background:
- Complete transposition of the great arteries (TGA) involves discordant ventriculoarterial connections, presenting unique challenges in cardiovascular development.
- Understanding normal coronary artery dimensions is crucial for assessing cardiac health, especially in congenital heart defects.
- Previous studies have not comprehensively evaluated coronary artery dimensions in TGA patients using both echocardiography and autopsy data.
Purpose of the Study:
- To establish reference values for normal coronary artery dimensions in pediatric patients with TGA.
- To compare echocardiographic measurements of coronary arteries in TGA patients with autopsy findings and normal heart data.
- To investigate the relationship between coronary artery dimensions and patient demographics (age, weight, length) in TGA.
Main Methods:
- Utilized two-dimensional echocardiography to determine normal coronary artery dimensions.
- Performed direct measurements of proximal coronary arteries from autopsy specimens of 20 patients with TGA.
- Correlated coronary artery dimensions with patient age, weight, and length, and analyzed orifice characteristics.
Main Results:
- Coronary artery diameters in TGA patients showed a linear increase with age, weight, and length, similar to normal hearts.
- No significant difference in the diameter of right and left coronary artery orifices was observed, despite right ventricular hypertrophy.
- Histological examination confirmed findings comparable to normal hearts, suggesting a consistent developmental pattern.
Conclusions:
- Proximal coronary artery development follows a relatively constant pattern in TGA, irrespective of altered hemodynamics.
- The functional implications of coronary artery orifice characteristics after the arterial switch procedure warrant further investigation.
Abstract:
The use of echocardiography established values for dimensions of normal coronary arteries in the setting of the heart with complete transposition (concordant atrioventricular and discordant ventriculoarterial connections) was evaluated. The diameters of the proximal coronary arteries measured at autopsy in 20 patients with complete transposition who had or had not undergone surgery were directly comparable with values determined in normal hearts by two-dimensional echocardiography. The values showed a linear increase with age, weight and length of the patients despite different branching patterns of the coronary arteries. Although there was right ventricular hypertrophy in all cases, the orifices of the right and left coronary arteries did not show any significant difference in diameter. Histologic examination and measurement of the arteries also revealed findings comparable with those in normal hearts. These findings suggest a relatively constant developmental pattern of the proximal coronary arteries despite different hemodynamics between the concordantly connected heart and the heart with complete transposition. In contrast, the functional significance of the stiff and slitlike orifices of the coronary arteries and their comparatively small diameters in relation to the ventricular wall thickness in four hearts studied after the arterial switch procedure for transposition merit further investigation.