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The coronary arteries in hearts with discordant atrioventricular connections
R McKay1, R H Anderson, A Smith
1Institute of Child Health, Alder Hey Children's Hospital, Liverpool, England.
Insights
This study reveals consistent coronary artery origins from two aortic sinuses in complex congenital heart defects. Understanding these origins is crucial for surgical interventions like the double switch operation.
Area of Science:
- Cardiovascular Anatomy
- Congenital Heart Disease
- Surgical Implications
Background:
- Complex congenital heart diseases, including congenitally corrected transposition and double-outlet right ventricle, present unique anatomical challenges.
- The origin and distribution of coronary arteries in these conditions are critical for surgical planning and patient outcomes.
Purpose of the Study:
- To investigate the precise origins of coronary arteries in hearts with discordant atrioventricular connections and double-outlet right ventricle or pulmonary atresia.
- To describe the coronary blood supply patterns to the morphologically right and left ventricles in these complex heart malformations.
Main Methods:
- Gross morphologic examination of 14 hearts with specified congenital anomalies.
- Histologic evaluation of two hearts to confirm vascular supply to nodal tissues.
Main Results:
- Consistently identified coronary artery origins from two aortic sinuses.
- The artery from sinus 1 typically supplied the morphologically right ventricle; sinus 2 usually supplied the left ventricle.
- Sinus nodal artery originated from the circumflex coronary artery, supplying the atrioventricular node.
Conclusions:
- The consistent coronary artery origins from specific aortic sinuses in these complex hearts have significant implications.
- Findings may inform strategies for coronary arterial transfer during double switch operations in patients with discordant atrioventricular connections.
Abstract:
Gross morphologic study of 14 hearts with congenitally corrected transposition or discordant atrioventricular connections and double-outlet right ventricle or pulmonary atresia disclosed consistently the origins of the coronary arteries from two aortic sinuses. With usual atrial arrangement, the artery arising in sinus 1 (right-hand facing), as seen from the noncoronary aortic sinus, supplied the morphologically right ventricle. Coronary blood supply to the morphologically left ventricle usually came from sinus 2 (left-hand facing), although in two hearts the circumflex branch was a continuation of the artery from sinus 1. The sinus nodal artery arose from the circumflex coronary artery, and histologic studies of two hearts demonstrated that blood supply to the anterior atrioventricular node also came from this vessel. Early branching and entrapment in fat or right ventricular muscle, as well as malalignment of aortic and pulmonary sinuses, occurred frequently. These findings may have implications for coronary arterial transfer in the double switch operation in hearts with discordant atrioventricular connections.