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(Circulation. 2002;106:1980.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Anatomic Variability in Coronary Arterial Distribution With Regard to the Arterial Switch Procedure

Parwis Massoudy, MD; Ahmet Baltalarli, MD; Marc R. de Leval, MD; Andrew Cook, BSc; Ulrich Neudorf, MD; Graham Derrick, MD; Karen P. McCarthy, BSc; Robert H. Anderson, BSc, MD, FRCPath

From the Cardiac Unit, Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.

Correspondence to Robert H. Anderson, Cardiac Unit, Institute of Child Health, University College London, 30 Guilford St, London WC1N 1EH, UK. E-mail R.Anderson{at}ich.ucl.ac.uk

Background— We investigated the coronary arterial origins and course and the position of the great arteries in hearts with discordant ventriculoarterial connections. At the same time, we sought to evaluate the practicality of alphanumeric classifications in accounting for surgically relevant features of the coronary arteries.

Methods and Results— We studied 200 postmortem hearts, noting the patterns of coronary arterial branching, the vertical and horizontal location of the arterial orifices within the aortic sinuses, the course of the proximal coronary arteries in relation to the aortic wall, and the relations of the great arteries and their respective commissures. All hearts examined had concordant atrioventricular and discordant ventriculoarterial connections. We found 7 of the 8 predicted patterns for sinusal origin of the 3 major coronary arteries and identified 5 different positions of the arterial trunks relative to each other. A correlation was found between less frequent relationships of the arterial trunks and unusual patterns of coronary arterial branching, as well as with mismatch between the valvar commissures.

Conclusions— The surgically relevant features of the coronary arteries in hearts with discordant ventriculoarterial connections are best described rather than classified. Correlations exist between certain, less frequent relations of the great arteries and unusual patterns of branching of the coronary arteries. The presence of unusual great arterial positions should alert the surgeon to potentially complicated arrangements of the origin and distribution of the coronary arteries.

Key Words: transposition of great vessels • coronary disease • surgery • anatomy • arteries