Coronary arterial patterns in transposition complexes: Anatomic and angiocardiographic studies

Abstract

The coronary arterial patterns were studied at necropsy in each of 115 cases with one of four transposition complexes as follows: (1) origin of both great vessels from the right ventricle (14 cases); (2) complete transposition of the great vessels (60 cases); (3) corrected transposition of the great vessels (15 cases); and (4) common ventricle with transposition of the great vessels (26 cases). These findings were correlated in 17 additional cases studied angiocardiographically. The important anatomic and angiocardiographic features were as follows: The right coronary artery arose in a normal position in 13 of the 14 cases of origin of both great vessels from the right ventricle studied anatomically and angiocardiographically. Among the other three entities studied the right coronary artery arose in an abnormal right posterior or right lateral position. The anterior descending coronary artery arose from the right coronary artery in each case of corrected transposition. In the majority of cases of common ventricle and in all cases of complete transposition and origin of both great vessels from the right ventricle, the anterior descending coronary artery arose as a branch of the left coronary artery. The left circumflex coronary artery arose from the right coronary artery in one third of the cases of complete transposition. In no other form of transposition was this pattern observed. The left coronary artery arose above the left aortic cusp in each condition studied. In common ventricle and corrected transposition, however, the left coronary artery arose in a more posterior position than in the other conditions. It is concluded that the coronary arterial pattern in the transposition complexes is frequently specific for certain conditions. Angiocardiography may be a valuable aid in differentiating one form of transposition from another.