Commissural Malalignment as a Predictor of Coronary Artery Abnormalities in Patients with Transposition of Great Arteries

Abstract Background In patients with transposition of the great arteries (TGA), commissural malalignment (CM) between semilunar valves may be associated with abnormal coronary (CA) pattern. We intend to assess the degree of CM with incidence of unusual CA anatomy. Methods We proposed a ratio to measure the distance of both ends of the anterior facing sinuses of the pulmonary valve from the facing commissure of the aortic valve. We labeled it as D1 and D2 distance. A ratio (C ratio) of the smaller distance (either D1 or D2 whichever is shorter) over the sum of both D1 and D2 was taken (D1 or D2 whichever is shorter/D1+D2). We related this ratio with the incidence of the unusual CA anatomy in D-TGA patients Results We had a total of 158 patients. We defined the point beyond which the C-Ratio becomes significantly associated with abnormal coronary artery pattern, this represents the median effective level (EL50). The EL50 of the C-Ratio was found to be equal to 31% (0.31). The prediction revealed that the CA pattern would most probably be usual when there is a minor commissural malalignment (C-Ratio less than the EL50) and most probably be unusual when there is a major malalignment (C-Ratio is greater than the EL50). The sensitivity was 71% and the specificity 88% (p-value <0.0001). Conclusions The C-Ratio helps to categorize the degree of CM as minor (less than 0.31) or major (more than 0.31). A higher C-Ratio predicts a higher incidence of unusual CA pattern

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Commissural Malalignment as a predictor of coronary artery abnormalities in patients with transposition of great arteries

Journal of Congenital Cardiology ◽

10.1186/s40949-020-00039-7 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Mohamed Al Nasef ◽

Mohammed H. Alghamdi ◽

Maria L. Bello Valls ◽

Ahmed M. Zahrani ◽

Ali AlAkfash ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Pulmonary Valve ◽

Transposition Of Great Arteries ◽

Coronary Artery Abnormalities ◽

Semilunar Valves ◽

Abnormal Coronary Artery ◽

Effective Level ◽

A Minor

Abstract Background In patients with transposition of the great arteries (TGA), commissural malalignment (CM) between semilunar valves may be associated with abnormal coronary (CA) pattern. We intend to assess the degree of CM with incidence of unusual CA anatomy. Methods We proposed a ratio to measure the distance of both ends of the anterior facing sinuses of the pulmonary valve from the facing commissure of the aortic valve. We labeled it as D1 and D2 distance. A ratio (C ratio) of the smaller distance (either D1 or D2 whichever is shorter) over the sum of both D1 and D2 was taken (D1 or D2 whichever is shorter / D1 + D2). We related this ratio with the incidence of the unusual CA anatomy in D-TGA patients. Results We had a total of 158 patients. We defined the point beyond which the C-Ratio becomes significantly associated with abnormal coronary artery pattern, this represents the median effective level (EL50). The EL50 of the C-Ratio was found to be equal to 31% (0.31). The prediction revealed that the CA pattern would most probably be usual when there is a minor commissural malalignment (C-Ratio less than the EL50) and most probably be unusual when there is a major malalignment (C-Ratio is greater than the EL50). The sensitivity was 71% and the specificity 88% (p-value < 0.0001). Conclusions The C-Ratio helps to categorize the degree of CM as minor (less than 0.31) or major (more than 0.31). A higher C-Ratio predicts a higher incidence of unusual CA pattern.

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The prevalence and types of coronary artery abnormalities in pediatric patients with Tetralogy of Fallot

10.21203/rs.3.rs-153158/v1 ◽

2021 ◽

Author(s):

Nima Mehdizadegan ◽

Kholud Saeidi ◽

Kambiz Keshavarz

Keyword(s):

Coronary Artery ◽

Tetralogy Of Fallot ◽

Coronary Arteries ◽

Heart Diseases ◽

Common Finding ◽

P Value ◽

Coronary Anomalies ◽

Coronary Artery Abnormalities ◽

Operation Knowledge ◽

Cyanotic Congenital Heart Diseases

Abstract Objectives: Tetralogy of fallot (TOF) is one of the most common diseases among cyanotic congenital heart diseases which is associated with 2-23% of coronary artery abnormalities. Pre-operation knowledge the anatomy of coronary arteries in patients with TOF eliminates damage to them during surgery and prevents post-operative complications such as myocardial ischemia and heart failure.Materials and methods:This retrospective study was done on all patients with TOF who were referred for diagnostic catheterization and angiography before total surgical correction from 2006-2016. All patients entered the study and all angiographic views including extreme caudal, LAO cranial , and selective coronary artery angiography were evaluated and reviewed accurately.Results: 332 cases of patients with TOF including from one month to 36 years old were reviewed. The prevalence of coronary artery abnormalities among them was 11.4% (38 from 322 individual). 9.1% and 15.3% of males and females had abnormal coronary anomalies but it was not significant statically (p-value: 0.064). In 13 of 38 patients with coronary anomalies , coronary arteries crossed right ventricular out flow tract (RVOT)(3.4%). The most common coronary abnormality was origin of the both main coronary arteries from left sinus of Valsalva.Conclusion:Compared with other populations, the abnormal arteries among the patients with TOF in our study is significant (11.4%) and accurate assessment of their courses is necessary before surgery. Single origin of coronary arteries from the left side was the most common finding in our study too.

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CABG With Internal Thoracic Artery in Children With Congenital Heart Defects: A Good Option When It Is the Only One

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120940151 ◽

2020 ◽

Vol 11 (6) ◽

pp. 748-752

Author(s):

Christian Kreutzer ◽

Gustavo Bastianelli ◽

Benjamin Chiostri ◽

Guillermo Gutierrez ◽

Daniel Alberto Klinger ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Valve Replacement ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Internal Thoracic Artery ◽

Pulmonary Valve ◽

Heart Defects ◽

Right Ventricular Outflow Tract ◽

Pulmonary Valve Replacement

Objective: Coronary complications may present during or after repair of congenital heart defects. We report coronary artery bypass grafting (CABG) by internal thoracic artery (ITA) grafts to either coronary artery in children with congenital anomalies. Methods: Four cases who underwent CABG with ITA grafts from March 2016 to March 2020 were retrospectively reviewed. Results: At the time of operation, patient’s ages and weight were 7 and 20 months old and 14 and 15 years old and 6.5, 10, 40, and 45 kg, respectively. Diagnosis were anomalous origin of the left coronary artery from the pulmonary artery with leftward lateral ostial origin (n = 1), neopulmonary annulus hypoplasia post arterial switch with contiguous right coronary artery (RCA) arising from the left facing sinus (n = 1), RCA stenosis after the Ross procedure (n = 1), and right coronary ostial obstruction after aortic valve replacement in truncus arteriosus (n = 1). Procedures included left ITA to left coronary ostium (n = 1), right ventricular outflow tract (RVOT) enlargement with pulmonary valve replacement with left ITA to RCA (n = 1), RVOT enlargement with pulmonary valve replacement with right ITA to RCA (n = 1), and aortic valve re-replacement, pulmonary valve replacement, and right ITA to RCA (n = 1). At last follow-up, all four patients were asymptomatic, with normal ventricular function, and all grafts were patent. Conclusions: The use of CABG in children is valuable alternative when dealing with complex coronary anatomy not suitable for classic repairs. In children, graft patency is required to be longer than 50 years; therefore, use of arterial grafts seems mandatory.

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Experience with balloon pulmonary valvuloplasty and predictors of outcome: a ten-year study

Cardiology in the Young ◽

10.1017/s1047951120000360 ◽

2020 ◽

Vol 30 (4) ◽

pp. 482-488

Author(s):

Sonia A. El-Saeidi ◽

Hala S. Hamza ◽

Hala M. Agha ◽

Mohammed M. Soliman ◽

Wael A. Attia ◽

...

Keyword(s):

Pressure Gradient ◽

Pulmonary Valve ◽

Pulmonary Stenosis ◽

Cross Sectional Study ◽

P Value ◽

Predictors Of Success ◽

Post Intervention ◽

Cross Sectional ◽

Valvular Pulmonary Stenosis ◽

A Minor

AbstractBackground:Balloon pulmonary valvuloplasty is the treatment of choice for patients with moderate to severe pulmonary valve stenosis.Methods:An observational retrospective cross-sectional study including neonates, small infants, and children who underwent balloon pulmonary valvuloplasty in the period from 2007 to 2016 in the cardiac catheterisation unit of the paediatric cardiology department in Cairo University. Multivariable models were built to report the predictors of the outcome of balloon pulmonary valvuloplasty and its complications.Results:A total of 1200 patients were included in the study and divided according to age into 3 groups: neonates and early infants (n = 282), infants (n = 362), and children (n = 556). Procedural success, defined as a drop pressure gradient across the pulmonary valve to less than or equal to 50% of the baseline measurements, was achieved in 82.7% of the patients. Multivariate analysis revealed that only infundibular pulmonary stenosis (p value 0.032), supravalvular in association with valvular pulmonary stenosis (p value <0.001), and pulmonary valve diameter by angiogram (p value <0.001) were significant predictors of success. The presence of supravalvular in association with valvular pulmonary stenosis (p value <0.001) was associated with a lower weight (p value 0.007) and higher right ventricular pressure before the intervention (p value <0.001), and a minor immediate drop in the pressure gradient post-intervention (p value <0.001) was found to be the most significant predictor of the occurrence of complications.Conclusion:The absence of infundibular and supravalvular stenosis and a large pulmonary valve diameter were the most significant predictors of success.

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