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. 2000 Mar;83(3):320–325. doi: 10.1136/heart.83.3.320

Coronary arterial origins in transposition of the great arteries: factors that affect outcome. A morphological and clinical study

J Li 1, R Tulloh 1, A Cook 1, M Schneider 1, S Ho 1, R Anderson 1
PMCID: PMC1729337  PMID: 10677414

Abstract

OBJECTIVE—Transfer of the coronary arteries is crucial during the arterial switch operation for transposition, but little attention has been paid to the position of their orifices relative to the valvar sinuses. The objective of this study was to determine the factors which are important for effective transfer and to determine potential surgical significance.
DESIGN—Morphological and clinical study.
SETTING—Two national centres for neonatal cardiac surgery.
PATIENTS—277 patients with transposition of the great arteries. One group comprised 88 necropsy specimens (ages ranging from 17 weeks of fetal life to 17 years old), and the other comprised 189 children undergoing surgery. The coronary artery orifices were inspected relative to the depth of the aortic sinuses (vertical origin), relative to the commissures between the valvar leaflets (radial origin), and their angle of exit from the aortic wall (angle of origin). The data were compared with the surgical results.
RESULTS—In the necropsy specimens, the vertical origin of the arteries was at, or above, the sinutubular junction in 20%, the radial origin was paracommissural in 3%, and the angle of origin was not orthogonal in 7%. Those with high take off and paracommissural origin were all intramural. In the clinical cases, those children with high take off, paracommissural origin or tangential origin had an increased risk at surgery.
CONCLUSIONS—In 20% of hearts, high take off, paracommissural orifice, or tangential origin of coronary arteries is found. This may be recognised preoperatively by echocardiography and may cause technical difficulty in transfer during the arterial switch procedure.


Keywords: transposition of the great arteries; coronary arteries; arterial switch operation; echocardiography; anatomy; congenital heart defects

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Figure 1  .

Figure 1  

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Vertical origin of the coronary artery orifices in the 62 specimens. The aortic root has been cut open and is represented as a flat plane. Open circles represent orthogonal origin of the coronary arteries and closed circles represent tangential or intramural coronary artery origins which would be more difficult to translocate during an arterial switch operation.

Figure 2  .

Figure 2  

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Representation of a right coronary artery with an orthogonal origin as seen in (left) an echocardiogram, and (right) a specimen photograph. The origin lies well within the aortic sinus and the echocardiographic case underwent successful switch operation with no complications. RCA, right coronary artery; LCA, left coronary artery; RV, right ventricle; AO, aorta.

Figure 3  .

Figure 3  

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View of a left coronary artery origin which is above the sinutubular junction and is tangential to the aortic wall as seen in (left) an echocardiogram, and (right) a specimen photograph. The coronary artery shown in the echocardiogram was intramural but relocation was possible during the arterial switch operation.

Figure 4  .

Figure 4  

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View of single origin of the coronary arteries from the right facing sinus with the left coursing between the aorta and pulmonary artery as seen in (left) an echocardiogram, and (right) a specimen photograph. Coronary artery relocation was not possible, the aorta being reconstructed so as to redirect flow into the coronary artery following the switch operation, without relocation. LAD, left anterior descending artery; PT, pulmonary trunk; SNA, sinus nodal artery.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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