ANGIOGRAPHIC EVIDENCE OF LONG-AXIS ROTATION IN ADDITION TO SHORT-AXISAORTOPULMONARY ROTATION - ITS IMPLICATION IN TRANSPOSITION OF THE GREAT-ARTERIES

To assess the pattern of aortic sinus in varied aortopulmonary rotatio ns and its clinical implications, three aortic sinuses at the diastoli c phase in true lateral view are identified in 53 angiograms of comple te transposition of the great arteries recorded between 1988 and 1993. The patients with the high takeoff of the coronary arteries found at surgery and in the literature were selected for additional investigati on. Six regions were defined on the horizontal plane. From left anteri or 89 degrees to 61 degrees, the non-facing sinus moved toward the ant erior aspect (one patient). From left anterior 60 degrees to left ante rior 1 degrees, the left-hand sinus moved gradually from an anterior t oward a posterior location (two patients). From directly anterior 0 de grees to right anterior 59 degrees, the right-hand sinus moved from po sterior toward an anterior position (30 patients). From right anterior 60 degrees to right posterior 105 degrees, the non-facing sinus moved posteriorly (20 patients). On approaching directly anterior 0 degrees and toward right anterior 60 degrees, the left-hand sinus was the low est in anterior transposition of the great arteries instead of the non -facing sinus, as in left anterior 90 degrees and in posterior transpo sition of the great arteries. High takeoff occurred commonly above the lowest left-hand sinus in anterior transposition of the great arterie s (2 cases here and 5 in the literature, 100%). In conclusion, aortopu lmonary rotations about the short and long axes were both evident on i dentification of the aortic sinus in various rotations. The aortic sin us did not rotate along the long-axis in anterior transposition of the great arteries, thus making the left-hand sinus, the lowest of this g roup, vulnerable to the high takeoff of the coronary arteries in anter ior transposition of the great arteries. (C) 1996 Wiley-Liss, Inc.