Coding of coronary arterial origin and branching in congenital heart disease: The modified Leiden Convention Adriana C. Gittenberger-de Groot, PhD, Wilke.

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Presentation transcript:

Coding of coronary arterial origin and branching in congenital heart disease: The modified Leiden Convention Adriana C. Gittenberger-de Groot, PhD, Wilke M.C. Koenraadt, MD, Margot M. Bartelings, MD, PhD, Regina Bökenkamp, MD, PhD, Marco C. DeRuiter, PhD, Mark G. Hazekamp, MD, PhD, Ad J.J. C. Bogers, MD, PhD, Jan M. Quaegebeur, MD, PhD, Martin J. Schalij, MD, PhD, Hubert W. Vliegen, MD, PhD, Robert E. Poelmann, PhD, Monique R.M. Jongbloed, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 156, Issue 6, Pages 2260-2269 (December 2018) DOI: 10.1016/j.jtcvs.2018.08.009 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 View from above. A, Influence of positional changes of the great arteries on the description of the semilunar sinuses. Regardless of the position of the aortic valve, 2 sinuses can be recognized facing the pulmonary valve. These are referred to as the facing sinuses, leaving 1 nonfacing sinus. B, Unambiguous numeric terminology that is not influenced by relative position of the great arteries: P, Posterior; R, right; L, Left; A, Anterior. Relative position of the aortic orifice: I = right posterior, II = right side-by-side, III = right anterior, IV = anterior, V = left anterior. Ao, Aortic; NF, nonfacing; F, facing; Pu, pulmonary. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2260-2269DOI: (10.1016/j.jtcvs.2018.08.009) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 View from above. A, Unseptated cardiac outflow tract at the future orifice level, showing a large septal and parietal outflow tract endocardial cushion and 2 small intercalated cushions. B, Septation of the orifice level with ingrowth of neural crest cells (green), in which 2 facing commissures (arrows) are formed between the aortic and the pulmonary orifice (B, C). D, The definitive situation in which each orifice contains 2 facing and 1 nonfacing sinus. pec, Parietal; sec, septal; IC, intercalated cushion; NF, nonfacing; F, facing; AO, aortic; Pu, pulmonary. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2260-2269DOI: (10.1016/j.jtcvs.2018.08.009) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Application of the Leiden Convention applying 3 subsequent steps (A-D) and additional information (E). For explanation, see text. Ao, Aortic; NF, nonfacing; LCA, left coronary artery; RCA, right coronary artery; LCx, left circumflex; Pu, pulmonary; LAD, left anterior descending; R, right; Cx, circumflex; L, left; BAV, bicuspid aortic valve. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2260-2269DOI: (10.1016/j.jtcvs.2018.08.009) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Variations in coronary anatomy in TGA, view from above. A, The most common form. B-D, Variations with a double sinus origin. E, Example of a single sinus 2 origin. F, The clinically most hazardous form is shown with the LCx taking off directly behind the facing commissure from sinus 2 and thereafter taking an interarterial/intramural course to the anterior aspect of the heart (indicated by an asterisk in the coding). The combination of L and Cx thereafter courses over the right ventricular outflow tract crossing anteriorly to the pulmonary orifice. R, Right; NF, nonfacing; Cx, circumflex; L, left. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2260-2269DOI: (10.1016/j.jtcvs.2018.08.009) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Frequency of variations in 103 cases TGA with right anterior position of the aorta (A), side-by-side position of the great arteries in DORV with subpulmonary ventricular septal defect (B), and anterior position of the aorta (C) (modified after Gittenberger-de Groot and colleagues4). The most common form (1LCx-2R) is found in cases with a right anterior position of the aorta. Of the complicated cases with an interarterial/intramural artery (1LCx*,R), 1 is found in the most common position seen in TGA, being right anterior, and 2 cases (1LCx*,R and 2RL*Cx) were seen in side-by-side great artery positions, mostly encountered in DORV. NF, Nonfacing. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2260-2269DOI: (10.1016/j.jtcvs.2018.08.009) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 This schematic figure presents the most common variations in coronary arterial patterning, viewed from above. A, The normally encountered situation. B-F, Less common variations. A dash (-) is used between branches that derive from a separate sinus (A-D). A comma is interposed when the branches arise from a separate orifice in the sinus (E, F). An asterisk is placed after an intra-arterial/intramural branch (E, F). Variation F is clinically the most hazardous with an interarterial/intramural course of a branch. In these cases, the artery commonly shares part of the aortic wall media with no adventitia interposed. The orifice of the artery is commonly present in the direct neighborhood of the facing commissure. R, Right; NF, nonfacing; Cx, circumflex; L, left. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2260-2269DOI: (10.1016/j.jtcvs.2018.08.009) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Schematic representation of classification in BAV disease with associated variations in coronary anatomy viewed from above (A-F), for example, separate ostia of the left main stem (B, E). The supposed “nonfacing/noncoronary” part of the aortic leaflet in case of a strictly bicuspid valve is indicated by a star in D to F. R, right; NF, nonfacing; Cx, Circumflex; L, left. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2260-2269DOI: (10.1016/j.jtcvs.2018.08.009) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

The modified Leiden Convention coronary coding system. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2260-2269DOI: (10.1016/j.jtcvs.2018.08.009) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions