Diagnostic Methods Congenital Heart Disease

With the increasing popularity of the Jatene procedure for the treatment of common or D-transposition of the great arteries (D-TGA), the preoperative definition of coronary artery anatomy in D-TGA has assumed great importance. Consequently, the reliability of two-dimensional echocardiography for determining the coronary artery anatomy was studied in 32 infants with D-TGA. Surgical observation of the coronary anatomy was used to assess the accuracy of the echocardiographic diagnosis. The coronary arteries were visualized in 29 of 32 patients (90%), predominantly with the use of parasternal and apical views. In the three remaining patients visualization of the coronary arteries was inadequate to allow determination of their anatomy. The coronary artery anatomy was correctly predicted in 25 of the 29 patients in whom the coronary arteries were visualized. The anatomic patterns included usual coronary anatomy for D-TGA (n = 16), left circumflex coronary from the right coronary artery (n = 6), single right coronary artery (n = 1), single left coronary artery (n = 1), and inverted origin of the coronary arteries (n = 1). The errors in the remaining four patients were (1) false-negative diagnosis of origin of the left circumflex coronary from the right coronary artery (n = 1); (2) false-positive diagnosis of origin of the left circumflex coronary from the right coronary artery (n = 1), and (3) diagnosis of origin of the left circumflex coronary from the right coronary artery when the correct diagnosis was single right coronary artery (n = 2). In conclusion, the coronary arteries could be visualized in 90% of patients with D-TGA and the anatomy was defined correctly in 86% of patients in whom the coronary arteries could be visualized. We anticipate that more experience will further improve the accuracy of two-dimensional echocardiography for defining coronary anatomy in patients with D-TGA. Circulation 75, No. 3, 557-564, 1987. IN 1975 Jatene reported the first successful anatomic correction of common or D-transposition of the great arteries (D-TGA) performed by switching the aorta and pulmonary artery and reimplanting the coronary arteries.1 Since then, several centers have reported excellent results using this approach for the surgical correction of D-TGA. Since coronary artery anatomy is highly variable in individuals with D-TGA,2'S9 accurate preoperative definition of the coronary anatomy is extremely valuable in patients for whom the arterial switch operation is contemplated.2 Consequently, aortic root or selective coronary angiography is usually From the Department of Cardiology, The Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston. Address for correspondence: Stephen P. Sanders, M.D., Department of Cardiology, The Children's Hospital, 300 Longwood Ave., Boston, MA 02115. Received Sept. 16, 1986; revision accepted Nov. 28, 1986. *Current address: Dipartimento Medico-Chirurgico, di Cardiologia Pediatrica, Ospedale "Bambino Gesu," P. ZA S. Onofrio, 4-010165 Rome, Italy. Vol. 75, No. 3, March 1987 performed before surgery to define the coronary artery anatomy. '0 Aortic root angiography may not adequately delineate the coronary anatomy and selective coronary angiography may be difficult to perform in the neonate, especially the neonate with D-TGA. Therefore, we investigated the reliability of two-dimensional echocardiography for defining the coronary artery anatomy in D-TGA. Subjects and methods Between August 1984 and February 1986, 61 consecutive patients underwent surgical repair of D-TGA at The Children's Hospital, Boston. In 21 of these patients the preoperative anatomy and/or physiology was not suitable for an arterial switch operation. All of these patients underwent intra-atrial or intraventricular repair of D-TGA. The coronary artery anatomy was not specifically investigated preoperatively, nor was it described in the operative report in these 21 patients. A preoperative two-dimensional echocardiographic examination was not performed in another eight of the 61 patients. The remaining 32 patients (age 1 day to 11 months, mean 56 557 by gest on A ril 0, 2017 http://ciajournals.org/ D ow nladed from