Download Variation of Coronary Artery Anatomy in Transposition of the Great

Variation of Coronary Artery Anatomy in
Transposition of the Great Arteries
Piya Samankatiwat
Ramathibodi Hospital
Mahidol University
Introduction
Anatomical variation of coronary artery in
TGA is complicated.
Literally, classification of coronary artery in
TGA is inhomogeneous.
The usual type is not that usual, only just
slightly more than 60%
Correct preoperative recognition is
sometimes difficult.
Influence on outcome of surgery is still
controversial.
Definition of coronary artery
Coronary artery morphology
Patterns in TGA (Leiden Convention)
The “normal” coronary disposition in TGA is:
1LCx 2R (the disposition appears inverted as compared with
the disposition in the normal heart).
The most frequent anomalies encountered are:
1L 2RCx, 1Cx 2RL, 1R 2LCx, 2LCxR, 2RLCx, 2CxRL,1RLCx.
These may pose special surgical problems or even
contraindicate the switch at arterial level.  in particular
single coronary artery and intramural type.
Muresian H. Coronary arterial anomalies and variations
Mædica A Journal of Clinical Medicine, Volume1 No.1 2006
Yacoub MH, Radley-Smith R. Thorax, 1978, 33, 418-424
Wernovsky G and Sanders SP
Coron Artery Dis. 1993;4:148–157.
Pasquali et al. Circulation. November 12, 2002
Patients and method
An observational study
20 consecutive patients underwent arterial
switch operation.
Anatomical patterns of coronary arteries were
recorded.
Special concern on difficult types.
Results
Median age 12 days (3-480 days)
Male:Female 3:1
14 newborns, 5 infants and 1 child
One Dextrocardia
Dextrocardia case
Results
1LCx 2R
60% (n=12)
1 usual type with separated orifice of
right ventricular branch from sinus 1.
1L 2RCx
25% (n=5)
2RLCX
15% (n=3)
2 cases posterior course of LCA
1 case anterior course
Results
1LCx 2R
60 %
N=12
1L 2RCx
25 %
N=5
0%
2RLCx
15 %
N=3
0%
0%
0%
Conclusion
Coronary artery pattern in TGA was inconsistent.
Usual pattern in only 60 %
Difficult to determine if higher risk of arterial switch
operation was associated with a particular type of coronary
artery anatomy.
Our series: all single coronary artery cases survive.
The value of preoperative recognition of the pattern of
coronary artery and outcome of surgery for TGA is still
skeptical.
Further observation
Thank you