Coronary echocardiography in 406 patients with d-loop transposition of the great arteries

• Published in: Journal of the American College of Cardiology Vol. 24; no. 3; pp. 763 - 768
• Main Authors: Pasquini, Luciano, Sanders, Stephen P., Parness, Ira A., Wernovsky, Gil, Mayer, John E., Van Der Velde, Mary E., Spevak, Philip J., Colan, Steven D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.1994
• Subjects: Child; Child, Preschool; Coronary Vessel Anomalies - complications; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessels - diagnostic imaging; Echocardiography; Female; Heart Septal Defects, Ventricular - complications; Heart Septal Defects, Ventricular - diagnostic imaging; Humans; Infant; Infant, Newborn; Male; Predictive Value of Tests; Reproducibility of Results; Transposition of Great Vessels - complications; Transposition of Great Vessels - diagnostic imaging; Transposition of Great Vessels - surgery
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(94)90026-4

Objectives. The reliability of two-dimensional echocardiography for determining the proximal coronary artery anatomy in d-loop transposition of the great arteries was investigated in 406 infants who underwent surgical repair at one institution. Background. The origin and proximal course of the main coronary arteries can affect the surgical results of the arterial switch operation. Preoperative determination of the coronary artery anatomy appears to be advantageous for the surgeon. Methods. All infants with d-loop transposition who underwent a two-dimensional echocardiogram and primary surgical repair at our institution between 1987 and 1992 were identified, and the echocardiographic, operative and, when available, autopsy reports were reviewed for coronary artery anatomy, presence of a ventricular septal defect and the spatial relation between the arterial roots. The two-dimensional echocardiographic findings were compared with surgical or autopsy findings. The relation between proximal coronary artery anatomy and 1) a ventricular Septal defect, and 2) the spatial orientation of the arterial roots was investigated. Twenty-seven infants diagnosed wills an intramural coronary artery were not included because they are the subjects of another report. Results. Excluding intramural coronary artery patterns, 10 different types of coronary artery anatomy were seen in these 406 patients. The coronary arteries were imaged adequately in 387 (95%) of the 406 patients. The coronary artery anatomy was determined correctly by two-dimensional echocardiography in 369 (95.4%) of the 387 patients, with 18 errors in diagnosis. During the most recent 2.5 years, 193 (98.5%) of 196 patients were diagnosed correctly, with three diagnostic errors. Patients with a ventricular septal defect or side-by-side great arteries are more likely to have an unusual coronary pattern. Conclusions. Echocardiography appears to be highly reliable for determining proximal coronary artery anatomy in d-loop transposition of the great arteries. An unusual coronary artery pattern is more likely in patients with side-by-side great arteries or posterior aorta or a ventricular septal defect, or both.