Abstract 18489: Abnormal Coronary Findings on Non-Invasive Computed Tomography Coronary Angiography in Adult Patients with Transposition of the Great Arteries Corrected by Arterial Switch Operation
Purpose: Early mortality and long-term outcome in patients with congenital transposition of the great arteries (TGA) corrected by arterial switch operation (ASO) mainly depend on the perfusion of the myocardium provided by the transferred coronary circulation. This study aimed to assess the prevalence of potential unfavorable coronary findings in adult patients after ASO using non-invasive computed tomography coronary angiography (CTA).
Methods: The study population consisted of 30 adult patients after ASO (22 male, 22±3 yrs.) referred for non-invasive evaluation of the coronary anatomy by CTA. First, the post-operative coronary anatomy pattern was described using the classification of Gittenberger-de Groot. Furthermore, all scans were reviewed on the presence of (1) significant coronary stenosis, defined as ≥50% luminal narrowing, (2) an inter-arterial coronary course, and (3) an acute angled coronary origin.
Results: A post-operative anatomy patterns of 1R-2LCx was observed in 24 patients (80%), 1RCx-2L in 5 patients (17%) and 2RLCx in 1 patient (3%). A total of 13 patients (43%) had abnormal coronary findings of which 1 patient (3%) had a significant stenosis in the proximal LAD, 5 patients (17%) had an inter-arterial coronary course (case examples in Figure 1) and 7 patients (23%) had an acute angled coronary origin. All 16 patients with a normal CT results had a post-operative coronary pattern of 1R-2LCx, whereas this pattern was only observed in 8/14 (57%) patients with abnormal coronary findings on CTA (P<0.005).
Conclusions: The current study demonstrated that abnormal coronary findings are frequently observed in adult patients with TGA corrected by ASO. Moreover, a significant association between the coronary anatomy and the presence of coronary abnormalities on CTA was observed, indicating that patients with a post-operative coronary anatomy pattern other than 1R-2LCx may be at higher risk to have potential malignant coronary findings on CTA.
- © 2012 by American Heart Association, Inc.