CLINICAL IMPLICATIONS OF SHORT-AXIS AORTOPULMONARY ROTATION ON JUXTACOMMISSURAL ORIGIN OF THE CORONARY-ARTERY IN TRANSPOSITION OF THE GREAT-ARTERIES AND SURGICAL STRATEGY

Background: The relationship of short-axis aortopulmonary rotation (AP R) with juxtacommissural origin of the coronary arteries (JOCA) in tra nsposition of the great arteries (TGA) has never been elucidated. The surgical outcome of arterial switch operation (ASO) is influenced by t he presence of JOCA. Methods: Fifteen patients with TGA who presented to our institution between 1988 and 1995, and 23 cases from the litera ture, all with documented JOCA and APR, were analyzed. Each coronary a rterial type was assigned to one of five patterns, according to simila rities of epicardial configuration. All our patients underwent an ASO with various techniques to deal with JOCA. Results: JOCA near the faci ng commissure (FC, 35 cases), were more frequent with anterior TGA (29 /31, 94%) except types 5cj and 9j that were seen with posterior and ri ght lateral TGA (4/4, 100%); whereas JOCA near the right-hand nonfacin g commissure (RNC, 3 cases) were related with posterior TGA. Eta-squar e analysis showed significant correlation between various JOCA and sho rt axis APR. Thirteen of our cases had JOCA near FC, two near RNC. Fiv e of the former in whom the coronary artery was excised as a single bu tton had a superior trapdoor; using a two-button technique three of th e former had a lateral funnel and one of the latter had a medial trapd oor for the JOCA; all survived although one late noncoronary death was noted. In the remaining six cases without augmentation, only one surv ived (8/1 vs 1/5, p < 0.02). Conclusion: JOCA in TGA was related to sh ort axis APR, generally near FC in anterior TGA (except types 5cj and 9j), and near the RNC in posterior TGA. A superior (lateral) or medial flap, to augment the coronary button for JOCA near FC or RNC is helpf ul for a successful ASO.