293 Anomalies of coronary artery ostia in common arterial trunk

Abstract

Tbx1 controls outflow tract development and coronary artery patterning, with subaortic coronary-permissive and subpulmonary coronary-refractory myocardial domains. Our hypothesis is that the potential “pulmonary identity” of the common arterial trunk (CAT) influences coronary ostia anomalies. We reviewed 46 heart specimens with CAT and 17 with normal anatomy (control). Position of the coronary ostia over the truncal circumference was measured in degrees as the direction from the middle of the valve orifice. CAT types were: 28 type I, 8 type II, 3 type III, 7 type IV. The truncal valve was bicuspid in 2, tricuspid in 36, quadricuspid in 7. Overall, 87% cases had malformations of the coronary ostia size, shape, location relative to the commissures or sinotubular junction. Left coronary ostium had abnormal shape or size in 33/46, right coronary ostium in 20/46 (p<0.01). Left coronary ostium was located above a commissure in 17% vs 2% for right coronary ostium (p<0.05) and above the sinotubular junction in 28% vs 10% (p = 0.053). Left coronary ostium was more posterior than in control (65° vs 0°, p<0.0001), right coronary ostium was located similar to control (195° vs 213°). The anterior intercoronary angle, reflecting pulmonary identity domain, was 229° in CAT vs 147° in control (p<0.0001). Left coronary ostium in CAT is more frequently abnormal than right coronary ostium. This might be due to the obligatory dorsal connection of left coronary ostium because of the large coronary-refractory subpulmonary domain in the ventral left part of the CAT.