Preoperative echocardiographic determination of the coronary anatomy in patients with transposition of the great arteries - helping or confusing the surgeon?

In this single center observational study we aimed to determine the accuracy of echocardiography in diagnosing the coronary artery anatomy in neonates with d-transposition of the great arteries before arterial switch operation and to evaluate the impact of an incorrect echocardiographic diagnosis on the intra- and postoperative course after surgery. Therefore, 131 neonates with (simple) d-transposition of the great arteries, diagnosed from 2004 to 2017, were analyzed. Coronary artery patterns described in preoperative echocardiography were compared to intraoperative findings and accuracy was evaluated concerning impact on the intra- and postoperative course. Intraoperatively, usual coronary artery anatomy (1LCx2R) was described in 90 patients (69%) and coronary artery variants in 41 patients (31%, 1L2RCx n = 18, others n = 23). Overall, echocardiographic diagnosis was correct in 69% (n = 90). When classifying in usual coronary artery anatomy vs. coronary artery variant, echocardiographic diagnosis was correct in 77.1% (92% in usual coronary artery versus 20% in coronary artery variants). While univariate analysis showed significantly longer duration of surgery (261 vs. 276 min, p = 0.042) and extracorporeal circulation time (165 vs. 178 min, p = 0.026) in patients with an incorrect preoperative echocardiographic diagnosis, multivariate analysis showed no influence of an incorrect diagnosis or of coronary artery pattern on the intraoperative course. The postoperative course was not significantly different in both groups. In conclusion, accuracy of echocardiographic diagnosis of coronary artery anatomy is high in usual coronary pattern (92%) but low in coronary artery variants (20%). A wrong echocardiographic diagnosis is not associated with an unfavorable intra- and postoperative course after arterial switch operation.