The size of the coronary arteries in children with complete transposition before and after the arterial switch operation

1994 ◽  
Vol 4 (4) ◽  
pp. 340-346 ◽  
Author(s):  
Koichi Yatsunami ◽  
Makoto Nakazawa ◽  
Masashi Seguchi ◽  
Kazuo Momma ◽  
Yasuharu Imai
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Arterial Switch Operation ◽  
Left Main ◽  
Main Trunk ◽  
Left Main Trunk ◽  
Complete Transposition ◽  
Switch Operation ◽  
The Right

AbstractThe size of the coronary arteries parallels the ventricular mass, thus it may be abnormal in complete transposition beyond infancy and could be influenced by the arterial switch operation. To investigate this possibility, we measured the diameters of the right, left main trunk, anterior descending, and circumflex coronary arteries before and three to seven years (mean 4.8) after the arterial switch operation in 17 patients with a “normal” distribution of the coronary arteries (so-called Shaher type 1). The values were compared with 18 controls who had Kawasaki disease with no apparent coronary arterial disease. The right, left anterior descending, and circumflex arteries were smaller than control values before the operation. The post-/preoperative ratios of the diameter were 1.16±0.11 for the right coronary artery, 1.18±0.16 for the left main trunk, 1.20±0.18 for the left anterior descending artery, and 1.22±0.26 for the circumflex artery. There were no significant differences among these values. After surgery, the right coronary artery was larger, but the left coronary arteries were smaller in the patients than in the controls: 2.5±0.3 vs 2.0±0.2 mm for the right coronary artery; 2.4±0.3 vs 2.7±0.1 mm for the left main trunk; 1.9±0.2 vs 2.4±0.2 mm for the left anterior descending artery; 1.6±0.4 vs 2.2±0.5 mm for the circumflex artery, respectively. The posterior descending coronary artery originated from the right coronary artery in all patients. The total cross-sectional area of the right coronary, left anterior descending, and circumflex arteries was 9.7±2.4 mm2in the patients, and 11.8±2.9 mm2in the controls (p>O. 1), suggesting that the increased size of the right coronary artery compensates for the small left coronary arteries. We conclude that the arterial system in complete transposition, with a large right coronary artery and small left coronary system, remains smaller than normal even at midterm follow-up after anatomic repair despite normalization of left ventricular volume and muscle mass.

Preoperative identification of coronary arterial anatomy in complete transposition, and outcome after the arterial switch operation

2002 ◽  
Vol 12 (3) ◽  
pp. 240-247 ◽  
Author(s):  
Colin J. McMahon ◽  
Howaida G. El Said ◽  
Timothy F. Feltes ◽  
Carmen H. Watrin ◽  
Beth A. Hess ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Left Coronary Artery ◽  
Arterial Switch Operation ◽  
Circumflex Coronary Artery ◽  
Arterial Switch ◽  
Complete Transposition ◽  
Switch Operation ◽  
The Right ◽  
Arterial Anatomy

Background: Perceived correlation between the coronary arterial anatomy in patients with complete transposition, and the outcome of the arterial switch procedure, has made preoperative identification of their patterns standard practice. Purpose: Our purpose was to assess the accuracy of preoperative echocardiographic identification of coronary arterial patterns, to evaluate the necessity of preoperative imaging by angiography, and to determine the impact of the coronary arterial anatomy on outcome. Methods: We reviewed the medical records of all patients referred for an arterial switch operation between August 1995 and January 2000. The anatomy as described at the time of the operation using the Leiden convention was compared to the preoperative echocardiographic and angiographic findings. Results: The procedure had been performed in 67 patients, at a mean age of 9 days, with a range from 3 days to 15 months. In 42 patients, the ventricular septum was intact, while 21 patients had a ventricular septal defect, and the other four had double outlet right ventricle with the aorta anterior and rightward. In 52 patients, the left coronary artery arose from sinus #1, and the right from sinus #2. In 8 patients, the interventricular branch of the left coronary artery arose from sinus #1, with the circumflex coronary artery arising together with the right coronary artery from sinus #2. In three patients, all three coronary arteries arose from sinus #1, while in the remaining individual patients, a large conal branch arose with the left coronary artery from sinus #1, the right coronary and left anterior descending arteries arose from sinus #1, all three coronary arteries took origin from sinus #2, and the left anterior descending and right coronary artery arose from sinus #1 with no circumflex coronary artery identifiable, respectively. In two patients (4%), we identified an intramural coronary arterial course. Echocardiography and angiography were comparable (81% versus 86%) in delineating the coronary arterial anatomy. Patients with a single arterial orifice, or an atypical coronary arterial anatomy, had a slightly longer stay on the intensive care unit, and in the hospital, but showed no difference in mortality. In fact, there was no early mortality (70% confidence limits; 0–2.9%), while two patients died late (2.9%). Conclusion: We conclude that complex coronary arterial anatomy does not preclude a successful arterial switch procedure, although patients with a single coronary artery, or other arterial patterns, had a slightly longer hospital course. Preoperative echocardiographic evaluation is comparable to non-selective coronary angiography. Irrespective of complexity, nonetheless, the coronary arteries can successfully be translocated, obviating the need for preoperative coronary angiography.

Chronological changes in stenosis of translocated coronary arteries on angiography after the arterial switch operation in children with transposition of the great arteries: comparison of myocardial scintigraphy and angiographic findings

2015 ◽  
Vol 26 (4) ◽  
pp. 638-643 ◽  
Author(s):  
Hisashi Sugiyama ◽  
Etsuko Tsuda ◽  
Hideo Ohuchi ◽  
Osamu Yamada ◽  
Isao Shiraishi
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Arterial Switch Operation ◽  
Myocardial Scintigraphy ◽  
Artery Stenosis ◽  
Left Main ◽  
Main Trunk ◽  
Left Main Trunk ◽  
Arterial Switch ◽  
Switch Operation

AbstractBackgroundThe peri-operative mortality of the arterial switch operation in neonates with transposition of the great arteries is considerably low; however, long-term outcomes of translocated coronary arteries still remain one of the most crucial issues.Methods and resultsA total of 110 neonates with transposition of the great arteries after arterial switch operation were evaluated; three (2.7%) late deaths occurred. The remaining 107 patients except for one underwent follow-up angiography. Angiography showed coronary artery stenosis in nine (8.4%), with right coronary artery lesions in two and left main trunk lesions in seven. In two patients, right coronary artery stenosis regressed during follow-up. In left main trunk lesions, the severity of stenosis improved in four, did not change in one, and progressed to total occlusion in two patients. In children with coronary artery stenosis, myocardial scintigraphy showed perfusion defects in five out of six (83%) with left main trunk with ⩾75% stenosis and in four out of four with left main trunk stenosis ⩾90%. In contrast, patients whose coronary artery stenosis disappeared during follow-up had no perfusion defects on scintigraphy.ConclusionsRegression of ostial stenosis of the transplanted coronary artery on angiogram was observed. The stenosis regressed over time in six patients; two coronary arteries with 99% stenosis and delayed angiographic enhancement of the distal coronary artery resulted in total occlusion within 1 year after the arterial switch operation. Combination of angiography and myocardial scintigraphy could be useful to differentiate deceptive stenosis from progressive stenosis.

scholarly journals Right Coronary Artery May Grow Even Better than Normal After Arterial Switch Operation for Complete Transposition of the Great Arteries

2020 ◽  
Author(s):  
Daisuke Machida ◽  
Yukihisa Isomatsu ◽  
Motohiko Goda ◽  
Shinichi Suzuki ◽  
Keiichiro Kasama ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Arterial Switch Operation ◽  
Control Group ◽  
Transposition Of Great Arteries ◽  
Arterial Switch ◽  
Complete Transposition ◽  
Switch Operation ◽  
The Right

Abstract Background: It is unclear if coronary arteries properly grow in patients who underwent arterial switch operation for complete transposition of the great arteries. The purpose of this study was to clarify the mode of coronary growth and size in these patients. Methods: Eighteen patients who underwent arterial switch operation for complete transposition of the great arteries from 2000 to 2012 in our institution, and in whom coronary angiography was performed in late operative phase, were enrolled in this study. Growth of coronary arteries was evaluated by cubage of coronary arteries based on analyses with coronary angiography. Coronary arteries were divided into small segments and each segment was approximated by a truncated right circular cone. The sum of the cubage of each truncated cone in one coronary artery was approximated as total cubage of the coronary. the coronary cubage index was then calculated by dividing total cubage of a coronary artery by the patient’s body surface area. The coronary cubage indexes of the enrolled patients were compared with that of control patients with healed Kawasaki disease.Results: The left coronary cubage indexes of the complete transposition of the great arteries group and the control group were 1.05 ± 0.34 and 0.94 ± 0.34 (p=0.598), respectively, and no significant deference was found between groups. On the contrary, the right cubage index of the complete transposition of great arteries group was significantly larger than the control group (1.08 ± 0.44 and 0.54 ± 0.37, respectively; p=0.007), and total coronary cubage index (left coronary index + right coronary index) of the complete transposition of the great arteries group was also larger than the control group as well (2.13 ± 0.7 and 1.47 ± 0.6, respectively; p=0.026).Conclusion: The left coronary arteries after arterial switch operation for complete transposition of great arteries grow as large as normal; however, the right coronary arteries possibly grow even larger.

scholarly journals Anatomic variations of coronary arteries: origins, branching patterns, and abnormalities

2019 ◽  
Vol 12 (3) ◽  
pp. 117-123
Author(s):  
Natatcha Khwansang ◽  
Vilai Chentanez
Keyword(s):  
Coronary Arteries ◽  
Clinical Symptoms ◽  
Anatomic Variations ◽  
Left Main ◽  
Myocardial Bridge ◽  
Main Trunk ◽  
Aortic Cusp ◽  
Left Main Trunk ◽  
Branching Patterns ◽  
The Right

AbstractBackgroundAnatomic variations in orifices, courses, branching patterns, and abnormalities of coronary arteries could affect blood supply, hemodynamic characteristics, and clinical symptoms, and could be a risk of atherosclerosis.ObjectivesTo investigate the location and number of both coronary orifices in the aortic cusps, branching patterns of left main trunk, dominant pattern of posterior interventricular artery (PIA), prevalence of right posterior diagonal artery (RPDA), myocardial bridge, and other abnormalities.MethodsWe dissected 95 heart specimens from cadavers of Thai donors without the history of surgery, and the dominant patterns, location and number of orifices in the aortic cusps, branching patterns, origin and number of conal arteries, and occurrence of RPDA were determined.ResultsDual aortic origin of the coronary orifice was the most common condition. Anomalous 2 orifices in the left aortic cusp were found in one specimen in which the right coronary artery (RCA) arose from aortic cusp and had an interarterial course. Right dominance and trifurcated form of left main trunk were found more frequently. Most frequently 2 conal arteries were found. RPDA was found in 45% and mostly originated from RCA. The prevalence of myocardial bridge was 62% and located mostly on the anterior interventricular artery (AIA).ConclusionsThe prevalence of right dominance, RPDA, the atypical origin of RCA from the left sinus, and the prevalence of myocardial bridges was more frequent than reported by others, whereas the dual aortic origin from both cusps and the prevalence of bifurcated left main trunk was less frequent.

scholarly journals Coronary artery ectasia in a child after arterial switch operation for transposition of the great arteries and suspected multisystem inflammatory syndrome in children associated with COVID-19: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Mohamed Sobh ◽  
Ulf Jensen-Kondering ◽  
Inga Voges ◽  
Simona Boroni Boroni Grazioli
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Rare Case ◽  
Arterial Switch Operation ◽  
Scar Tissue ◽  
Long Distance ◽  
Arterial Switch ◽  
Switch Operation ◽  
The Right ◽  
Inflammatory Syndrome

Abstract Background Multisystem inflammatory syndrome in children (MIS-C) with features resembling Kawasaki disease has been reported in association with coronavirus disease 2019 (COVID-19). Case summary We report the rare case of a 22 months old boy with a history of operated simple transposition of the great arteries (TGA), who developed features of MIS-C likely to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection and involving the coronary arteries. Cardiovascular magnetic resonance imaging and cardiac catheterization showed long-distance ectasia of both coronary arteries after their origins and an origin stenosis of the right coronary artery with a perfusion defect. The patient was treated with oral anticoagulation together with antiplatelet therapy and remains under careful monitoring. Discussion This rare case demonstrates that also patients with TGA after the arterial switch operation (ASO) can develop coronary artery dilatation in association with MIS-C. The most interesting finding in this patient was that the origins of the reimplanted coronary arteries were not dilated. We speculate that scar tissue formation in the area of coronary artery transfer after ASO has prevented proximal coronary artery dilation.

scholarly journals Child with Kawasaki Disease Complicated by A Single Right Coronary Artery

2021 ◽  
Vol 15 ◽  
pp. 117954682110107
Author(s):  
Ryota Nakagawa ◽  
Hirotaka Ishido ◽  
Yoichi Iwamoto ◽  
Mai Sekine ◽  
Taichi Momose ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Right Coronary Artery ◽  
Left Main ◽  
Main Trunk ◽  
Left Main Trunk ◽  
Conference Abstract ◽  
First Case ◽  
Aneurysmal Dilation ◽  
Single Right Coronary Artery

A 3-year-old boy was referred to our hospital for management of Kawasaki disease at 5 days of illness. Echocardiographic examination on admission suggested aneurysmal dilation of the right coronary artery and a possible aorta-left main trunk connection. However, detailed echocardiography at 12 days of illness revealed an abnormal bifurcation of the proximal right coronary artery and no real connection of the aorta-left main trunk, all of which indicated the presence of a single right coronary artery. These diagnoses were confirmed by selective coronary angiography, which was performed later. Considering the difficulties in diagnosing congenital coronary anomalies, which may increase the risk of future fatal events, knowing the disease entity of the congenital coronary arterial anomaly is important for the accurate evaluation of coronary arteries in patients with Kawasaki disease. To the best of our knowledge, this is the first case report of a patient with Kawasaki disease complicated by a single right coronary artery; however, following a search of the literature, we found a brief conference abstract written in Japanese relating to the same clinical condition.

Contrast media injection into right coronary artery caused thrombus extraction to aorta that may have resulted in left main trunk thrombosis

2011 ◽  
Vol 27 (1) ◽  
pp. 37-42
Author(s):  
Atsushi Ikeda ◽  
Masayuki Inagaki ◽  
Shigeru Fukuzawa ◽  
Juji Sugioka ◽  
Shinichi Okino ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Contrast Media ◽  
Right Coronary Artery ◽  
Left Main ◽  
Main Trunk ◽  
Left Main Trunk
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