CORONARY ECHOCARDIOGRAPHY IN 406 PATIENTS WITH D-LOOP TRANSPOSITION OF THE GREAT-ARTERIES

Objectives. The reliability of two dimensional echocardiography for de termining the proximal coronary artery anatomy in d-loop transposition of the great arteries was investigated in 406 infants who underwent s urgical repair at one institution. Background. The origin and proximal course of the main coronary arteries can affect the surgical results of the arterial switch operation. Preoperative determination of the co ronary artery anatomy appears to be advantageous for the surgeon. Meth ods. All infants with d-loop transposition who underwent a two-dimensi onal echocardiogram and primary surgical repair at our institution bet ween 1987 and 1992 were identified, and the echocardiographic, operati ve and, when available, autopsy reports were reviewed for coronary art ery anatomy, presence of a ventricular septal defect and the spatial r elation between the arterial roots. The two-dimensional echocardiograp hic findings were compared with surgical or autopsy findings. The rela tion between proximal coronary artery anatomy and 1) a ventricular sep tal defect, and 2) the spatial orientation of the arterial roots was i nvestigated. Twenty-seven infants diagnosed with an intramural coronar y artery were not included because they are the subjects of another re port. Results. Excluding intramural coronary artery patterns, 10 diffe rent types of coronary artery anatomy were seen in these 406 patients. The coronary arteries were imaged adequately in 387 (95%) of the 406 patients. The coronary artery anatomy was determined correctly by two- dimensional echocardiography in 369 (95.4%) of the 387 patients, with 18 errors in diagnosis. During the most recent 2.5 years, 193 (98.5%) of 196 patients were diagnosed correctly, with three diagnostic errors . Patients with a ventricular septal defect or side-by-side great arte ries are more likely to have an unusual coronary pattern. Conclusions. Echocardiography appears to be highly reliable for determining proxim al coronary artery anatomy in d-loop transposition of the great arteri es. An unusual coronary artery pattern is more likely in patients with side-by-side great arteries or posterior aorta or a ventricular septa l defect, or both.