The Coronary Circulation in Complete Transposition of the Great Vessels.

While the anatomy of the coronary arteries in complete transposition of the great vessels has been studied by several authors, the overall problem of adequacy of the coronary blood supply in this condition has received less attention. Spitzer (1923) described the probable embryological basis for partial or complete transposition of the coronary arteries. Astley and Parsons (1952) thought that myocardial ischmmia was an important factor in causing cardiac-enlargement in cases of complete transposition of the great vessels. Keith et al. (1953) dissected the coronary arteries in 37 cases of complete transposition, and in 1958 reviewed their anatomy in 80 cases, differentiating them into four main patterns. With the development of techniques for the correction of complete transposition of the great vessels such considerations are of considerable importance. Apart from the anatomical abnormalities that may occur, e.g. a single coronary artery, an ischaemic myocardium may be partly responsible for the high mortality from any form of surgical procedure in cases of complete transposition. The object of this paper is to report the cases of complete transposition of the great vessels seen in Guy's Hospital in whom any abnormal feature of the coronary arteries, the myocardium, or the endocardium was found at autopsy. Other reports about this are reviewed, and the probable explanation of myocardial ischwmia in cases of complete transposition is discussed.