Ann Thorac Surg 2003;75:429
© 2003 The Society of Thoracic Surgeons
Invited commentary
Hiromi Kurosawa, MDa
a Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, Japan
e-mail: kurosawa{at}hij.twmu.ac.jp
Dr Chiu and associates reported an interesting paper on the coronary artery pattern in congenitally corrected transposition of the great arteries. It is worthwhile for surgeons to understand the detailed anatomy of the coronary arteries relating to the variable segmental relations of the atrium, ventricles, and great arteries in complex congenital cardiac anomalies. The conclusions of this paper were: (1) the peripheral coronary artery pattern is related to the apicocaval ipsilaterality and (2) the central coronary artery pattern is depended on the aortopulmonary relation.
In complex cardiac anomalies, the anterior descending coronary artery is highly related to the displacement and development of the infundibular septum. If the infundibular septum is malaligned to the trabecular septum, there might be two anterior descending arteries, one of which is the anterior descending artery reaching to the apex and the other could be the conus branch not reaching the apex. We previously reported this configuration between type 2 and 7b and between type 4 and 9 in transposition of the great arteries [1].
Although there is no set rule, the anatomical configuration usually has tendency to be certain way. If the tendency of the relationship between the coronary artery anatomy and the infundibular septum displacement can be defined in congenitally corrected transposition, a surgical implication for double switch operation will be clearer to us in terms of arterial switch or Rastelli type operation with an intraventricular rerouting and extracardiac conduit.
References
- Kurosawa H., Imai Y., Takanashi Y., Hoshino S., Sawatari K., Kawada M. Infundibular septum and coronary anatomy in Jatene operation. J Thorac Cardiovasc Surg 1986;91:572-583.[Abstract]
