Coronary arterial size late after the atrial inversion procedure for transposition of the great arteries: Implications for the arterial switch operation

Zahid Amin, Doff B. McElhinney, Philip Moore, V. Mohan Reddy, Frank L. Hanley

Research output: Contribution to journalArticle

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Abstract

Background: Coronary flow reserve in the hypertrophied ventricle is reduced. One contributing factor may be the size of the proximal coronary arteries. In patients who undergo atrial inversion procedures for transposition of the great arteries, the left coronary artery supplies the pulmonary ventricle and may be smaller than the right coronary artery. We hypothesized that the dimensions of the coronary arteries may correlate with symptomatic status after atrial inversion and may be an important factor when these patients are considered for the arterial switch operation. Methods: The proximal left and right coronary arteries were measured in 9 patients with transposition and failure of the systemic right ventricle after atrial inversion, 10 asymptomatic patients after atrial inversion, and 10 patients with normal hearts. The diameters of the coronary arteries were indexed to body surface area and compared. Results: The absolute and indexed diameters of the right coronary artery were greater in symptomatic patients than in asymptomatic patients (indexed: 3.1 ± 0.6 vs 2.4 ± 0.4 mm/m2, P < .001) or control patients (2.0 ± 0.3, P < .001), and the absolute diameter of the left coronary artery was smaller (2.9 ± 0.7 vs 3.6 ± 0.5 mm, P = .003 [asymptomatic], 3.6 ± 0.5 mm, P = .01 [control]). In symptomatic patients, the absolute and indexed diameters of the left coronary artery were smaller than those of the right (indexed: 2.1 ± 0.6 vs 3.1 ± 0.6 mm/m2, P < .001). By contrast, there was no difference in asymptomatic patients (2.2 ± 0.5 vs 2.4 ± 0.4 mm/m2, P = .44), and the left coronary artery was larger in normal control patients (2.2 ± 0.4 vs 2.0 ± 0.3 mm/m2, P < .001). Conclusions: Differences in the sizes of the proximal coronary arteries may be related to symptomatic status in patients with transposition of the great arteries who have undergone an atrial inversion procedure, as well as to the efficacy of ventricular retraining. When pulmonary artery banding and subsequent arterial switch are considered for patients with a Mustard or Senning procedure and a failing systemic right ventricle, the size of the proximal coronary arteries may be an important factor and should be evaluated with preoperative imaging studies.

Original languageEnglish (US)
Pages (from-to)1047-1052
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume120
Issue number6
DOIs
StatePublished - Jan 1 2000

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Transposition of Great Vessels
Coronary Vessels
Arterial Switch Operation
Heart Ventricles
Body Surface Area
Pulmonary Artery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Coronary arterial size late after the atrial inversion procedure for transposition of the great arteries : Implications for the arterial switch operation. / Amin, Zahid; McElhinney, Doff B.; Moore, Philip; Reddy, V. Mohan; Hanley, Frank L.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 120, No. 6, 01.01.2000, p. 1047-1052.

Research output: Contribution to journalArticle

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abstract = "Background: Coronary flow reserve in the hypertrophied ventricle is reduced. One contributing factor may be the size of the proximal coronary arteries. In patients who undergo atrial inversion procedures for transposition of the great arteries, the left coronary artery supplies the pulmonary ventricle and may be smaller than the right coronary artery. We hypothesized that the dimensions of the coronary arteries may correlate with symptomatic status after atrial inversion and may be an important factor when these patients are considered for the arterial switch operation. Methods: The proximal left and right coronary arteries were measured in 9 patients with transposition and failure of the systemic right ventricle after atrial inversion, 10 asymptomatic patients after atrial inversion, and 10 patients with normal hearts. The diameters of the coronary arteries were indexed to body surface area and compared. Results: The absolute and indexed diameters of the right coronary artery were greater in symptomatic patients than in asymptomatic patients (indexed: 3.1 ± 0.6 vs 2.4 ± 0.4 mm/m2, P < .001) or control patients (2.0 ± 0.3, P < .001), and the absolute diameter of the left coronary artery was smaller (2.9 ± 0.7 vs 3.6 ± 0.5 mm, P = .003 [asymptomatic], 3.6 ± 0.5 mm, P = .01 [control]). In symptomatic patients, the absolute and indexed diameters of the left coronary artery were smaller than those of the right (indexed: 2.1 ± 0.6 vs 3.1 ± 0.6 mm/m2, P < .001). By contrast, there was no difference in asymptomatic patients (2.2 ± 0.5 vs 2.4 ± 0.4 mm/m2, P = .44), and the left coronary artery was larger in normal control patients (2.2 ± 0.4 vs 2.0 ± 0.3 mm/m2, P < .001). Conclusions: Differences in the sizes of the proximal coronary arteries may be related to symptomatic status in patients with transposition of the great arteries who have undergone an atrial inversion procedure, as well as to the efficacy of ventricular retraining. When pulmonary artery banding and subsequent arterial switch are considered for patients with a Mustard or Senning procedure and a failing systemic right ventricle, the size of the proximal coronary arteries may be an important factor and should be evaluated with preoperative imaging studies.",
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T1 - Coronary arterial size late after the atrial inversion procedure for transposition of the great arteries

T2 - Implications for the arterial switch operation

AU - Amin, Zahid

AU - McElhinney, Doff B.

AU - Moore, Philip

AU - Reddy, V. Mohan

AU - Hanley, Frank L.

PY - 2000/1/1

Y1 - 2000/1/1

N2 - Background: Coronary flow reserve in the hypertrophied ventricle is reduced. One contributing factor may be the size of the proximal coronary arteries. In patients who undergo atrial inversion procedures for transposition of the great arteries, the left coronary artery supplies the pulmonary ventricle and may be smaller than the right coronary artery. We hypothesized that the dimensions of the coronary arteries may correlate with symptomatic status after atrial inversion and may be an important factor when these patients are considered for the arterial switch operation. Methods: The proximal left and right coronary arteries were measured in 9 patients with transposition and failure of the systemic right ventricle after atrial inversion, 10 asymptomatic patients after atrial inversion, and 10 patients with normal hearts. The diameters of the coronary arteries were indexed to body surface area and compared. Results: The absolute and indexed diameters of the right coronary artery were greater in symptomatic patients than in asymptomatic patients (indexed: 3.1 ± 0.6 vs 2.4 ± 0.4 mm/m2, P < .001) or control patients (2.0 ± 0.3, P < .001), and the absolute diameter of the left coronary artery was smaller (2.9 ± 0.7 vs 3.6 ± 0.5 mm, P = .003 [asymptomatic], 3.6 ± 0.5 mm, P = .01 [control]). In symptomatic patients, the absolute and indexed diameters of the left coronary artery were smaller than those of the right (indexed: 2.1 ± 0.6 vs 3.1 ± 0.6 mm/m2, P < .001). By contrast, there was no difference in asymptomatic patients (2.2 ± 0.5 vs 2.4 ± 0.4 mm/m2, P = .44), and the left coronary artery was larger in normal control patients (2.2 ± 0.4 vs 2.0 ± 0.3 mm/m2, P < .001). Conclusions: Differences in the sizes of the proximal coronary arteries may be related to symptomatic status in patients with transposition of the great arteries who have undergone an atrial inversion procedure, as well as to the efficacy of ventricular retraining. When pulmonary artery banding and subsequent arterial switch are considered for patients with a Mustard or Senning procedure and a failing systemic right ventricle, the size of the proximal coronary arteries may be an important factor and should be evaluated with preoperative imaging studies.

AB - Background: Coronary flow reserve in the hypertrophied ventricle is reduced. One contributing factor may be the size of the proximal coronary arteries. In patients who undergo atrial inversion procedures for transposition of the great arteries, the left coronary artery supplies the pulmonary ventricle and may be smaller than the right coronary artery. We hypothesized that the dimensions of the coronary arteries may correlate with symptomatic status after atrial inversion and may be an important factor when these patients are considered for the arterial switch operation. Methods: The proximal left and right coronary arteries were measured in 9 patients with transposition and failure of the systemic right ventricle after atrial inversion, 10 asymptomatic patients after atrial inversion, and 10 patients with normal hearts. The diameters of the coronary arteries were indexed to body surface area and compared. Results: The absolute and indexed diameters of the right coronary artery were greater in symptomatic patients than in asymptomatic patients (indexed: 3.1 ± 0.6 vs 2.4 ± 0.4 mm/m2, P < .001) or control patients (2.0 ± 0.3, P < .001), and the absolute diameter of the left coronary artery was smaller (2.9 ± 0.7 vs 3.6 ± 0.5 mm, P = .003 [asymptomatic], 3.6 ± 0.5 mm, P = .01 [control]). In symptomatic patients, the absolute and indexed diameters of the left coronary artery were smaller than those of the right (indexed: 2.1 ± 0.6 vs 3.1 ± 0.6 mm/m2, P < .001). By contrast, there was no difference in asymptomatic patients (2.2 ± 0.5 vs 2.4 ± 0.4 mm/m2, P = .44), and the left coronary artery was larger in normal control patients (2.2 ± 0.4 vs 2.0 ± 0.3 mm/m2, P < .001). Conclusions: Differences in the sizes of the proximal coronary arteries may be related to symptomatic status in patients with transposition of the great arteries who have undergone an atrial inversion procedure, as well as to the efficacy of ventricular retraining. When pulmonary artery banding and subsequent arterial switch are considered for patients with a Mustard or Senning procedure and a failing systemic right ventricle, the size of the proximal coronary arteries may be an important factor and should be evaluated with preoperative imaging studies.

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