Abstract 10214: Coronary Artery Anatomy in Congenital Heart Disease with Posterior Aorta: Medical and Surgical Implications
Background: Since Van Praagh's report of transposition of the great arteries (TGA) with posterior aorta, it is well known that this entity, with aortopulmonary rotation (APR) >right lateral 90°, usually had the coronary artery pattern of a normal heart (pattern IX), which is a mirror-image to the usual pattern seen in TGA with anterior aorta (pattern I). We hypothesize that various coronary artery patterns might exist in other congenital heart diseases with posterior aorta, to which we pose its implications.
Methods: Coronary artery patterns and APR were identified in 665 patients that presented from 1960 to 2008 with TGA (n=76), tetralogy of Fallot (TF) (n=517), congenitally corrected transposition (CCT) (n=62), and anatomically corrected malposition (ACM) (n=10). The APR was deduced by the aortic sinus patterns via angiography at the lateral projection.
Results: The coronary artery patterns in all 665 patients are shown in the Table. Posterior aorta could be identified as the nonfacing sinus located in the posterior half of the aortic root in all cases (n=188). There are six coronary artery patterns (patterns O, I, II, IV, IX and X) (Figure). Anomalous coronary artery with the left anterior descending traversing the infundibulum was noted in 12 patients with TF. Neither of them had a posterior aorta. Pattern IX was noted in 5 patients with posterior TGA. Pattern X was seen in each patient with posterior CCT and posterior ACM (APR >left lateral 90°). In patients with posterior aorta, transannular patch could be performed by the anterior patch technique since the right coronary artery is located on the posterior/lateral aspect of the pulmonary annulus.
Conclusion: Posterior aorta could be identified when the nonfacing sinus occupied the posterior half of aortic root on lateral projection, usually with coronary artery anatomy belonged to the patterns IX and X. It is safe to perform anterior transannular incision to relieve pulmonary outflow obstruction in TF, TGA, CCT,
- © 2011 by American Heart Association, Inc.