Sequential diagnosis of coronary arterial anatomy in congenitally corrected transposition of the great arteries

Background. The objective of this study was to analyze coronary arteries (CA) in congenitally corrected transposition (CCT) and to determine the influence of aortopulmonary rotation on its pattern systematically. Precise CA anatomy is surgically needed in the current era of double switch for CCT. Methods. We collected data on 62 patients who had CCT with situs solitus or inversus between 1981 and 1999. Coronary artery anatomy was analyzed as it related to apical position, atrial situs, ventricular looping, and aortopulmonary rotation. Five main types with similar variants of epicardial configuration at the base of the heart were categorized into five central patterns (patterns X, O, I, II, and IV). Results. The right CA coursed to the left in CCT with situs solitus, and to the right in CCT with situs inversus; and to the more posterior atrioventricular groove in both without apicocaval ipsilaterality. However, in CCT with more apicocaval ipsilaterality, the left circumflex might shift posterior to the right CA. With the same aortopulmonary rotation, the two groups had similar central patterns, and eta-square analysis showed that the evolution from patterns X, O, I, II, toward IV (n = 1, 36, 15, 9 to 1) was dependent on clockwise aortopulmonary rotation (p < 0.00000). Conclusions. Peripheral CA pattern in the atrioventricular groove was dictated by apicocaval ipsilaterality anteroposteriorly and ventricular looping dextrosinistrally, irrespective of atrial situs. The central CA pattern near the aortic sinus depended on aortopulmonary rotation due to "marriage of convenience" between them, and thus was predictable from arterial relations irrespective of its disease category. (C) 2003 by The Society of Thoracic Surgeons.