CORONARY-ARTERY ANATOMY IN COMPLETE TRANSPOSITION OF THE GREAT-ARTERIES

Knowledge of the variations in coronary artery pattern is important in the arterial switch operation for complete transposition of the great arteries (TGA). As autopsy specimens provide the most definitive mean s of identifying the coronary anatomy, 255 hearts with complete TGA we re reviewed by a single pathologist. The age of the patients ranged fr om 1 day to 34 years (mean, 2.9 years). The origin of the coronary art eries was defined as seen by an observer looking from the pulmonary ar tery toward the aorta. The usual pattern with the right coronary arter y originating from the right hand sinus and the left coronary artery f rom the left hand sinus (184 cases) and the circumflex coronary artery arising from the right coronary artery (46 cases) accounted for 90% o f the cases. Eleven other patterns were identified. The usual coronary artery pattern was more prevalent in TGA with the aorta in a right an terior or anterior position (74.8%) than in TGA with a side-by-side re lationship of the great arteries (38.9%). In only 2 cases (0.8%) was a n aortic intramural course of the left coronary artery identified. The latter 2 cases confirm our belief that an aortic intramural course of the left coronary artery or the left anterior descending coronary art ery must be assumed when the vessel has an aberrant origin from the ri ght sinus or when it is in intimate relationship with the commissure b etween the right and left sinuses and courses between the great arteri es. In the vast majority of specimens a favorable coronary artery patt ern with regard to feasibility of the arterial switch operation was en countered.