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Omer SO, Alhabshan FM, Jijeh AMZ, Caimbon NC, Enriquez CC, Männer J, Yelbuz TM. Is Transposition of the Great Arteries Associated With Shortening of the Intrapericardial Portions of the Great Arterial Trunks? An Echocardiographic Analysis on Newborn Infants With Simple Transposition of the Great Arteries to Explore an Animal Model-Based Hypothesis on Human Beings. J Am Heart Assoc 2021; 10:e019334. [PMID: 34278802 PMCID: PMC8475693 DOI: 10.1161/jaha.120.019334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
Background The pathogenesis of transposition of the great arteries (TGA) as a congenital heart defect of the outflow tract with discordant ventriculoarterial connections remains an enigma. TGA usually have parallel great arteries suggesting that deficient torsion of the embryonic arterial heart pole might cause discordant ventriculoarterial connections. It has been speculated that deficient elongation of the embryonic outflow tract might prevent its normal torsion resulting in TGA. The aim of our study was to clarify whether the intrapericardial portions of the great arteries in human patients with TGA might be indeed shorter than in normal hearts. Methods and Results Thirty-four newborns with simple TGA and 35 newborns with normal hearts were analyzed by using images of the outflow tract in their echocardiograms and the following defined lengths of the great arteries were measured: aortic length 1, (AoL-1) and aortic length 2 (AoL-2) = distance between left and right aortic valve level and origin of the brachiocephalic artery, respectively. Pulmonary trunk length 1 (PTL-1) and pulmonary trunk length 2 (PTL 2) = distance between left and right pulmonary valve level and origin of left and right pulmonary artery, respectively. All measurements of the AoL were significantly shorter in TGA compared to normal hearts (AoL-1: 1.6±0.2 versus 2.05±0.1; P<0.0001; AoL-2: 1.55±0.2 versus 2.13±0.1; P<0.0001). With regard to the pulmonary trunk (PT), PTL-1 and PTL-2 were found to be shorter and longer, respectively, in TGA compared with normal hearts, reflecting the differences in the spatial arrangement of the PT between the 2 groups as in TGA the PT is showing a mirror image of the normal anatomy. However, the overall length of the PT between the 2 groups did not differ. Conclusions Our data demonstrate that, compared with normal newborns, the ascending aorta is significantly shorter in newborns with TGA whereas the overall length of the PT does not differ between the 2 groups. This finding is in accord with the animal model-based hypothesis that TGA may result from a growth deficit at the arterial pole of the embryonic heart.
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Affiliation(s)
- Seham O. Omer
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Fahad M. Alhabshan
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Abdulraouf M. Z. Jijeh
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Natalia C. Caimbon
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Carmelita C. Enriquez
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Jörg Männer
- Institute for Anatomy and EmbryologyUMGGeorg‐August‐University of GöttingenGöttingenGermany
| | - Talat Mesud Yelbuz
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
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Roderick ME, Maria N, Crucean A, Stickley J, Barron DJ, Anderson RH. Defining transposition: What have we learnt? Ann Pediatr Cardiol 2020; 14:63-66. [PMID: 33679062 PMCID: PMC7918027 DOI: 10.4103/apc.apc_181_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/21/2020] [Accepted: 08/04/2020] [Indexed: 11/06/2022] Open
Abstract
Understanding transposition is important for all who hope to effectively treat patients with the condition. The variants of the condition are frequently debated in the literature. We describe an unusual variant of transposition, in which despite the arterial roots being supported by morphologically inappropriate ventricles, the roots themselves were normally related, with the intrapericardial arterial trunks spiraling as they extended into the mediastinum. The specimen was identified following the re-categorization of our archive, and we subsequently conducted a detailed analysis of the underlying morphology. Using the principles of sequential segmental analysis, we compared the morphology with standard examples previously described. We show how it was the recognition of such hearts that promoted that concept that the combination of connections across the atrioventricular and ventriculo-arterial junctions was the essence of transposition. In the most common variant, the arrangements are concordant at the atrioventricular junctions, but discordant at the ventriculo-arterial junctions. We suggest that the overall arrangement of discordant ventriculo-arterial connections is best described simply as “transposition.” When the discordant ventriculo-arterial connections are combined with similarly discordant connections at the atrioventricular junctions, the transposition is congenitally corrected. We point out that the use of “d” and “l” as prefixes does not distinguish between transposition and its congenitally corrected variant. For those using segmental notations, the correct description for the rare variant found in the setting of a posteriorly located aortic root with the usual atrial arrangement is transposition (S, D, NR).
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Affiliation(s)
- Max E Roderick
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom.,Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nikita Maria
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom.,Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Adrian Crucean
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom.,Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Stickley
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - David J Barron
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Robert H Anderson
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
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Maria N, Roderick ME, Stickley J, Drury NE, Jones TJ, Barron DJ, Brawn WJ, Anderson RH, Crucean A. Anatomical Studies of Transposition - An Argument for a Unifying Morphological Classification. Semin Thorac Cardiovasc Surg 2020; 32:920-926. [PMID: 32450210 DOI: 10.1053/j.semtcvs.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/15/2020] [Indexed: 11/11/2022]
Abstract
In the setting of transposition, recognition of the variability in the morphology of the outflow tracts and the arterial trunks is essential for surgical repair. Presence of a unifying system for classification would minimize the risk of misunderstanding. We examined an archive of 142 unrepaired hearts with transposition, defined as the combination of concordant atrioventricular and discordant ventriculoarterial connections, combined with the clinical records of 727 patients undergoing the arterial switch procedures. In the setting of usual atrial arrangement, we found the aortic root in leftward or posterior location in up to 5% of our cohorts, making the common term "d-transposition" ambiguous. Variability in the relationship of the trunks was commoner in the setting of deficient ventricular septation, especially when the trunks were side-by-side (14% vs 5.5% when the ventricular septum was intact). Bilateral infundibulums were present in 14% of cases, and bilaterally deficient infundibulums in 3.5%. Both of these findings were more common with deficient ventricular septation. Fibrous continuity between the tricuspid and pulmonary valves was not always seen with perimembranous defects, particularly when there were bilateral infundibulums. Fibrous continuity between the leaflets of the tricuspid and mitral valves, in contrast, proved a unifying characteristic of the perimembranous defect. The combination of concordant atrioventricular and discordant ventriculoarterial connections is best described simply as "transposition," with precision provided when details are given of atrial arrangement and the relationships of the arterial trunks.
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Affiliation(s)
- Nikita Maria
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom; Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Max E Roderick
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom; Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Stickley
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Nigel E Drury
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Timothy J Jones
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - David J Barron
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - William J Brawn
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Robert H Anderson
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Adrian Crucean
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom; Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
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Kuhle B, Chihade J, Schimmel P. Relaxed sequence constraints favor mutational freedom in idiosyncratic metazoan mitochondrial tRNAs. Nat Commun 2020; 11:969. [PMID: 32080176 PMCID: PMC7033119 DOI: 10.1038/s41467-020-14725-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/30/2020] [Indexed: 01/05/2023] Open
Abstract
Metazoan complexity and life-style depend on the bioenergetic potential of mitochondria. However, higher aerobic activity and genetic drift impose strong mutation pressure and risk of irreversible fitness decline in mitochondrial (mt)DNA-encoded genes. Bilaterian mitochondria-encoded tRNA genes, key players in mitochondrial activity, have accumulated mutations at significantly higher rates than their cytoplasmic counterparts, resulting in foreshortened and fragile structures. Here we show that fragility of mt tRNAs coincided with the evolution of bilaterian animals. We demonstrate that bilaterians compensated for this reduced structural complexity in mt tRNAs by sequence-independent induced-fit adaption to the cognate mitochondrial aminoacyl-tRNA synthetase (aaRS). Structural readout by nuclear-encoded aaRS partners relaxed the sequence constraints on mt tRNAs and facilitated accommodation of functionally disruptive mutational insults by cis-acting epistatic compensations. Our results thus suggest that mutational freedom in mt tRNA genes is an adaptation to increased mutation pressure that was associated with the evolution of animal complexity. Bilaterian mitochondria-encoded tRNA genes accumulate mutations at higher rates than their cytoplasmic tRNA counterparts, resulting in idiosyncratic structures. Here the authors suggest an evolutionary basis for the observed mutational freedom of mitochondrial (mt) tRNAs and reveal the associated co-adaptive structural and functional changes in mt aminoacyl-tRNA synthetases.
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Affiliation(s)
- Bernhard Kuhle
- The Skaggs Institute for Chemical Biology, Scripps Research, La Jolla, CA, 92037, USA. .,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA. .,Department of Chemistry, The Scripps Research Institute, La Jolla, CA, 92037, USA.
| | - Joseph Chihade
- Department of Chemistry, Carleton College, 1 North College St., Northfield, MN, 55057, USA
| | - Paul Schimmel
- The Skaggs Institute for Chemical Biology, Scripps Research, La Jolla, CA, 92037, USA. .,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA. .,Department of Chemistry, The Scripps Research Institute, La Jolla, CA, 92037, USA. .,Department of Molecular Medicine, The Scripps Florida Research Institute, Jupiter, FL, 33458, USA.
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5
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Castellanos DA, McKenzie ED, Morris SA. Fetal and postnatal echocardiographic imaging of transposition of the great arteries with the aortic valve posterior to the pulmonary valve. Echocardiography 2019; 36:1005-1008. [PMID: 30801777 DOI: 10.1111/echo.14292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/24/2019] [Indexed: 11/27/2022] Open
Abstract
Transposition of the great arteries (TGA) with a posterior aorta is an uncommon but historically important variant of TGA. In this arrangement, the aorta is posterior to the pulmonary valve, maintains fibrous continuity with the mitral valve, and arises from the right ventricle. We present a case of fetal echocardiography demonstrating TGA with a posterior aorta. Postnatal transthoracic echocardiography and intra-operative assessment confirm the anatomy. To the best of our knowledge, this is the first published case of this anatomic lesion by fetal echocardiography.
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Affiliation(s)
- Daniel A Castellanos
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Emmett Dean McKenzie
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Shaine A Morris
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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Frescura C, Thiene G. The Spectrum of Congenital Heart Disease with Transposition of the Great Arteries from the Cardiac Registry of the University of Padua. Front Pediatr 2016; 4:84. [PMID: 27713877 PMCID: PMC5032087 DOI: 10.3389/fped.2016.00084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/28/2016] [Indexed: 11/13/2022] Open
Abstract
Transposition of the great arteries (TGA) is a cardiac condition in which the arterial trunks arise from the inappropriate ventricle: the aorta from the right ventricle and the pulmonary trunk from the left ventricle [discordant ventriculo-arterial (VA) connection]. In complete TGA, the discordant VA connection is associated with situs solitus or inversus and concordant atrioventricular (AV) connection. The hemodynamic consequence of these combined connections is that systemic and pulmonary circulations function in "parallel" rather than in "series". The presence of situs solitus or inversus associated with both AV and VA discordant connections characterizes a different anatomical complex known as "corrected TGA." In these hearts, the double discordance at AV and VA levels permits a normal sequence of the blood flow from the right atrium to the pulmonary artery and from the left atrium to the aorta. The systemic and pulmonary circulation in these hearts functions regularly in series, and the blood sequence is "physiologically corrected." Thus, the term transposition, either complete or corrected, identifies two precise, different anatomical complexes, both characterized by VA discordance. However, among congenital heart disease (CHD), there are other anatomical complexes with discordant VA connection in the setting of isomeric atrial situs (right or left) or of univentricular AV connections (double inlet or absent connections). In these latter conditions, the term "transposition" is still necessary to stress that the great arteries are "transposed" in relation to the ventricular septum (aorta from the right ventricle and pulmonary trunk from the left ventricle) but certainly does not figure out the anatomical complexes named complete or corrected transposition. We reviewed the hearts with discordant VA connection of our Anatomical Collection, consisting of 1,640 specimens with CHD, with the aim to discuss the anatomy and the frequency of the anatomical variants of TGA and to clarify terminology and classification. The knowledge of the precise anatomy of these malformation are really important for clinical diagnosis and surgical planning.
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Affiliation(s)
- Carla Frescura
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School , Padua , Italy
| | - Gaetano Thiene
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School , Padua , Italy
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Baraona F, Valente AM, Porayette P, Pluchinotta FR, Sanders SP. Coronary Arteries in Childhood Heart Disease: Implications for Management of Young Adults. ACTA ACUST UNITED AC 2012. [PMID: 24294539 DOI: 10.4172/2155-9880.s8-006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Survival of patients with congenital heart defects has improved dramatically. Many will undergo interventional catheter or surgical procedures later in life. Others will develop atherosclerotic or post-surgical coronary heart disease. The coronary artery anatomy in patients with congenital heart disease differs substantially from that seen in the structurally normal heart. This has implications for diagnostic procedures as well as interventions. The unique epicardial course seen in some defects could impair interpretation of coronary angiograms. Interventional procedures, especially at the base of the heart, risk injuring unusually placed coronary arteries so that coronary artery anatomy must be delineated thoroughly prior to the procedure. In this review, we will describe the variants of coronary artery anatomy and their implications for interventional and surgical treatment and for sudden death during late follow-up in several types of congenital heart defects including: tetralogy of Fallot, truncus arteriosus, transposition of the great arteries, double outlet right ventricle, congenitally corrected transposition of the great arteries and defects with functionally one ventricle. We will also discuss the coronary abnormalities seen in Kawasaki disease.
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Affiliation(s)
- Fernando Baraona
- Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA ; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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8
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Ishibashi N, Aoki M, Watanabe M, Nakajima H, Aotsuka H, Fujiwara T. Intraventricular rerouting for transposition of the great arteries with posterior aorta: Ventricular septal defect creation and total resection of the infundibular septum. J Thorac Cardiovasc Surg 2005; 130:593-4. [PMID: 16077446 DOI: 10.1016/j.jtcvs.2005.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Massoudy P, Baltalarli A, de Leval MR, Cook A, Neudorf U, Derrick G, McCarthy KP, Anderson RH. Anatomic variability in coronary arterial distribution with regard to the arterial switch procedure. Circulation 2002; 106:1980-4. [PMID: 12370223 DOI: 10.1161/01.cir.0000033518.61709.56] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Parwis Massoudy
- Cardiac Unit, Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
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10
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Chiu IS, Chu SH, Wang JK, Wu MH, Chen MR, Cheng CF, Hung CR. Evolution of coronary artery pattern according to short-axis aortopulmonary rotation: a new categorization for complete transposition of the great arteries. J Am Coll Cardiol 1995; 26:250-8. [PMID: 7797758 DOI: 10.1016/0735-1097(95)00187-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We studied the correlation between coronary artery pattern and aortopulmonary rotation in complete transposition of the great arteries. BACKGROUND Classifications of the coronary arteries in complete transposition are puzzling and incomplete. METHODS Coronary artery anatomy and relation of the great arteries were identified at angiography, echocardiography, surgical intervention or autopsy in 76 patients with complete transposition from 1988 to 1993. Five main types (type 0 and Shaher types 1,2,4 and 9) and their similar variants of epicardial configuration were categorized into five patterns (O, I, II, IV and IX). In addition, data from 568 cases from published reports were collected for analysis. RESULTS As the aorta rotated from a left anterior to a directly anterior location relative to the pulmonary trunk, the left anterior descending coronary artery arose from the left-hand sinus together with the right coronary artery (type 0, one case decreased to no cases); then it gradually shifted to the left to have the same origin as the left circumflex coronary artery from the right-hand sinus (type 1, 10 cases increased to 146, p < 0.0003). When the aorta rotated farther clockwise from directly anterior to right anterior (type 1, 146 cases increased to 235; type 2, 9 cases increased to 50, p < 0.0006) or from right anterior to right lateral (type 1, 235 cases decreased to 6 cases; type 2, 50 cases decreased to 20, p < 0.00000), the left circumflex coronary artery tended to move retropulmonically and originated from the left-hand sinus with the right coronary artery (type 2). When the aorta moved from right anterior to right lateral (type 2, 50 cases decreased to 20; type 4, 13 cases increased to 14, p < 0.031) or from right lateral to right posterior (type 2, 20 cases decreased to 1; type 4, 14 cases increased to 16, p < 0.0003), the right coronary artery shifted to the right-hand sinus anteaortically to join the left anterior descending coronary artery (type 4). Finally, the left anterior descending coronary artery combined with the left circumflex coronary artery (type 9, 12 cases increased to 21, p = 0.407) to become the usual pattern for normally related great arteries. Eta-square analysis showed that the evolution from pattern O to IX was dependent on clockwise aortopulmonary rotation. CONCLUSIONS The coronary arteries in complete transposition of the great arteries can be classified into five patterns and their evolution deduced on the basis of aortopulmonary rotation. Dependence of coronary artery type on aortopulmonary rotation made it possible to anticipate the coronary pattern from the relation of the great arteries in transposition.
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Affiliation(s)
- I S Chiu
- Department of Surgery, National Taiwan University Hospital, Taipei
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11
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Pasquini L, Sanders SP, Parness IA, Wernovsky G, Mayer JE, Van der Velde ME, Spevak PJ, Colan SD. Coronary echocardiography in 406 patients with d-loop transposition of the great arteries. J Am Coll Cardiol 1994; 24:763-8. [PMID: 8077550 DOI: 10.1016/0735-1097(94)90026-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The reliability of two-dimensional echocardiography for determining the proximal coronary artery anatomy in d-loop transposition of the great arteries was investigated in 406 infants who underwent surgical 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 coronary artery anatomy appears to be advantageous for the surgeon. METHODS All infants with d-loop transposition who underwent a two-dimensional echocardiogram and primary surgical repair at our institution between 1987 and 1992 were identified, and the echocardiographic, operative and, when available, autopsy reports were reviewed for coronary artery anatomy, presence of a ventricular septal defect and the spatial relation between the arterial roots. The two-dimensional echocardiographic findings were compared with surgical or autopsy findings. The relation between proximal coronary artery anatomy and 1) a ventricular septal defect, and 2) the spatial orientation of the arterial roots was investigated. Twenty-seven infants diagnosed with an intramural coronary artery were not included because they are the subjects of another report. RESULTS Excluding intramural coronary artery patterns, 10 different 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 arteries are more likely to have an unusual coronary pattern. CONCLUSIONS Echocardiography appears to be highly reliable for determining proximal coronary artery anatomy in d-loop transposition of the great arteries. An unusual coronary artery pattern is more likely in patients with side-by-side great arteries or posterior aorta or a ventricular septal defect, or both.
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Affiliation(s)
- L Pasquini
- Department of Cardiology, Harvard Medical School, Boston, Massachusetts
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Pasquini L, Sanders SP, Parness IA, Colan SD, Van Praagh S, Mayer JE, Van Praagh R. Conal anatomy in 119 patients with d-loop transposition of the great arteries and ventricular septal defect: an echocardiographic and pathologic study. J Am Coll Cardiol 1993; 21:1712-21. [PMID: 8496542 DOI: 10.1016/0735-1097(93)90392-e] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We sought to study the range of conal morphology in transposition of the great arteries with ventricular septal defect and their embryologic and surgical implications. BACKGROUND Conal anatomy in transposition of the great arteries and ventricular septal defect is variable and might affect surgical repair. METHODS Conal anatomy was explored using two-dimensional echocardiography in 119 patients with transposition of the great arteries and a large ventricular septal defect who presented between 1984 and 1991. The influence of conal anatomy on surgical technique was determined by review of the operative reports. Specimens of transposition of the great arteries with unusual conal anatomy were selected from the Cardiac Registry for comparison with the echocardiograms. RESULTS One hundred five patients (88.2%) had subaortic conus only with no subpulmonary conus (Group 1). Subarterial conus was present bilaterally in eight patients (6.7%) (Group 2). Four patients (3.4%) had only subpulmonary conus with no (or minimal) subaortic conus (Group 3). Among these four patients, the aorta was posterior to the pulmonary artery in one patient, side by side relative to the pulmonary artery in two patients and slightly anterior in the fourth patient. Subarterial conus was absent bilaterally in two patients (1.7%) (Group 4); the aorta was slightly posterior in one and side by side with the pulmonary artery in the other. CONCLUSIONS This variability of conal anatomy in transposition of the great arteries with ventricular septal defect implies four mechanisms by which transposition can occur. The conal anatomy appeared to affect surgical repair in Groups 1 and 2 insofar as it influenced ventricular outflow tract obstruction. In Groups 3 and 4, an arterial switch operation was performed in four of the six patients. The posterior location of the aorta obviated the need for the Lecompte maneuver in two of these four patients. In the remaining two cases in Groups 3 and 4, the condition was repaired by directing the left ventricular outflow across the ventricular septal defect to the aorta using a patch, with or without placement of a conduit from the right ventricle to the pulmonary artery.
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Affiliation(s)
- L Pasquini
- Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115
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Abstract
An unusual case of posterior transposition of the great arteries, with previously undescribed aortic obstruction is described. The patient, who underwent an arterial switch operation, was found at surgery to have a mass of myxomatous tissue arising from the tricuspid valve. This finding was responsible for the hemodynamically significant aortic stenosis.
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Miyake T, Yokoyama T, Shirotani H. Transposition of the great arteries with posterior aorta: detection by two-dimensional echocardiography. Pediatr Cardiol 1990; 11:102-4. [PMID: 2349139 DOI: 10.1007/bf02239573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Two-dimensional echocardiographic features in a case of transposition of the great arteries (TGA) with the posterior aorta are described. The unusual arrangement of the great arteries and the presence of bilateral conuses and aortic-mitral fibrous continuity were clearly demonstrated by angiocardiography and then confirmed at surgery.
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Affiliation(s)
- T Miyake
- Department of Pediatric Cardiology, Kinki University School of Medicine, Osaka, Japan
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16
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Virdi IS, Keeton BR, Monro JL. Complete transposition with posteriorly located aorta and multiple ventricular septal defects. Int J Cardiol 1988; 21:347-51. [PMID: 3229869 DOI: 10.1016/0167-5273(88)90112-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A case of complete transposition with posterior aorta and multiple ventricular septal defects is reported. One perimembranous defect, diagnosed preoperatively, was closed while performing a Mustard operation. Three coexisting muscular ventricular septal defects, however, were missed and posed considerable problems at surgery. Although not previously reported, it should be possible to diagnose this condition preoperatively with a view to correction.
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Affiliation(s)
- I S Virdi
- Wessex Cardiothoracic Centre, Southampton General Hospital, Shirley, U.K
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17
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Béland MJ, Paquet M. Two-dimensional echocardiographic features of complete transposition of the great arteries with posterior aorta. J Am Soc Echocardiogr 1988; 1:463-5. [PMID: 3272797 DOI: 10.1016/s0894-7317(88)80031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- M J Béland
- Department of Pediatrics, Montreal Children's Hospital, Québec, Canada
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18
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Kurosawa H, Imai Y, Takanashi Y, Hoshino S, Sawatari K, Kawada M, Takao A. Infundibular septum and coronary anatomy in Jatene operation. J Thorac Cardiovasc Surg 1986. [DOI: 10.1016/s0022-5223(19)36027-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Kurosawa H, Van Mierop LH. Surgical anatomy of the infundibular septum in transposition of the great arteries with ventricular septal defect. J Thorac Cardiovasc Surg 1986. [DOI: 10.1016/s0022-5223(19)38490-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Büchler JR, Bembom JC, Büchler RD. Transposition of the great arteries with posterior aorta and subaortic conus: anatomical and surgical correlation. Int J Cardiol 1984; 5:13-8. [PMID: 6693205 DOI: 10.1016/0167-5273(84)90052-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Three hearts studied at autopsy with transposition of the great arteries and posterior aorta with isolated or predominantly subaortic conus are described. In all cases the aorta was posterior and to the right of the pulmonary trunk. In two cases it was significantly distant from the pulmonary trunk and in one it was very close. The caliber of the pulmonary trunk was larger than that of the aorta: greater than 2:1 in two cases and less than 2:1 in one case. A well developed subaortic conus was seen in all cases and a small subpulmonary conus in one case. In the other two cases, the pulmonary valve was in fibrous continuity with the mitral valve. In all cases the aortic valve was higher than the pulmonary valve, the relative heights above the ventricles being 25/20, 25/30 and 40/60 mm, respectively. The left coronary artery ran posteriorly and to the left of the pulmonary trunk in all the cases. The length of the main stem of the left coronary artery was 11, 11 and 30 mm, respectively. We discuss the significance of this type of transposition of the great arteries for techniques currently used for surgical correction.
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21
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Marín-García J, Edwards JE. Reply. Am J Cardiol 1982. [DOI: 10.1016/0002-9149(82)90495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Interposition of a modified aortic homograft conduit as main pulmonary trunk in anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg 1981. [DOI: 10.1016/s0022-5223(19)39333-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Piccoli GP, Wilkinson JL, Arnold R, Musumeci F, Hamilton DI. Appraisal of the Mustard procedure for the physiological correction of “simple” transposition of the great arteries. J Thorac Cardiovasc Surg 1981. [DOI: 10.1016/s0022-5223(19)39334-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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de la Cruz MV, Arteaga M, Espino-Vela J, Quero-Jiménez M, Anderson RH, Díaz GF. Complete transposition of the great arteries: types and morphogenesis of ventriculoarterial discordance. Am Heart J 1981; 102:271-81. [PMID: 7258100 DOI: 10.1016/s0002-8703(81)80018-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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25
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Abstract
Clinical, angiocardiographic and necropsy data in a case of atypical d-transposition of the great arteries with an anterior pulmonary trunk are described. The unusual arrangement of the great arteries and the presence of bilateral coni were demonstrated with angiocardiography and confirmed on pathologic study.
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26
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Kinsley RH, Levin SE, O'Donovan TG. Transposition of the great arteries associated with a double left ventricular outflow tract. Heart 1979; 42:483-6. [PMID: 508480 PMCID: PMC482187 DOI: 10.1136/hrt.42.4.483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A case is described in which, at semilunar valve level, the aorta and pulmonary artery arose from inappropriate ventricles. Despite this, the outflow tracts to both vessels originated from the left ventricle. Embryologically, it is speculated that this anomaly is the result of normal rotation of the proximal conus, without concomitant truncal inversion, and excessive leftward shift of the proximal conus and conal septum or anterior and rightward deviation of the anterior segment of the ventricular septum. Surgical repair using a double conduit between the right ventricle and pulmonary artery and left ventricle and aorta, respectively, was unsuccessful.
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27
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Chacko KA. Ventricular inversion without transposition of great arteries. Am J Cardiol 1978; 42:696-7. [PMID: 696657 DOI: 10.1016/0002-9149(78)90660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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28
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