Coronary artery anatomy in anatomically corrected malposition of the great arteries and their surgical implications

Objectives: Coronary artery (CA) anatomy of anatomically corrected malposition of the great arteries (ACM) has not been well elucidated. We studied the CA pattern and their association with the aortopulmonary rotation (APR). Methods: CA anatomy and APR of ACM were identified by image or surgical intervention. The degree of APR was defined by the pattern of the aortic sinus of Valsalva on the lateral angiogram or computed tomography (CT). Results: Four CA types were presented in 10 patients and literatures. Six patients had the same CA type as the usual pattern in transposition of the great arteries (type 1); and two had left anterior descending (LAD) from the left-hand facing sinus that also gave rise to the right CA (RCA) (type 0). One patient had LAD from the left-hand facing sinus while RCA and circumflex artery from the right-hand facing sinus (type 10); and single CA from the anterior left-hand sinus (type 3c) was identified in another. APR was left anterior in type 1 and more lateral in types 0 and 3c; and left posterior in type 10 (p = 0.001). The usual pulmonary trans-annular incision can only be performed in case of type 10 CA after posterior APR (10%, 1/10). In the majority (90%, 9/10 with the CA type 1, 0, and 3c), the RCA is in front of the pulmonary annulus, and the atrioventricular groove patch plasty posterior to the RCA had to be adopted for a trans-annular patch. Conclusions: The observed CA pattern was correlated with APR. APR identified by the aortic sinus pattern could implicate the CA patterns and the surgical options in ACM.