Variation in Coronary Anatomy in Adult Patients Late After Arterial Switch Operation: A Computed Tomography Coronary Angiography Study Caroline E. Veltman,

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Date of download: 5/28/2016 Copyright © The American College of Cardiology. All rights reserved. From: A CT Study of Coronary Arteries in Adult Mustard.

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Variation in Coronary Anatomy in Adult Patients Late After Arterial Switch Operation: A Computed Tomography Coronary Angiography Study Caroline E. Veltman, MD, Saskia L.M.A. Beeres, MD, PhD, Deborah N. Kalkman, MS, Tim P. Kelder, MD, Philippine Kiès, MD, PhD, Hubert W. Vliegen, MD, PhD, Mark G. Hazekamp, MD, PhD, Victoria Delgado, MD, PhD, Lucia J.M. Kroft, MD, PhD, Ernst E. van der Wall, MD, PhD, Adriana C. Gittenberger-de Groot, MD, PhD, Arthur J.H.A. Scholte, MD, PhD, Martin J. Schalij, MD, PhD, Monique R.M. Jongbloed, MD, PhD The Annals of Thoracic Surgery Volume 96, Issue 4, Pages 1390-1397 (October 2013) DOI: 10.1016/j.athoracsur.2013.05.004 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Leiden classification for the preoperative and postoperative coronary anatomy pattern. The coronary arteries arise from the facing sinuses, and the noncoronary sinus is called the nonfacing (NF) sinus. The observer is positioned in the NF cusp, looking toward the pulmonary trunk (PT), and the sinus on the right is designated “sinus 1” and the one on the left is “sinus 2.” The coronary arteries are considered separately. (A) The most common coronary artery pattern. (B) The most frequently observed variant coronary artery pattern in patients with transposition of the great arteries, with an aberrant circumflex artery (Cx) arising from the right coronary artery (R). (C) A single-ostium coronary anatomy, in which the right coronary artery, left anterior descending coronary artery (L), and circumflex artery all arise from the same sinus. (Ao = aorta; Neo-Ao = neoaorta. Directional arrows: A = anterior; L = left; P = posterior; R = right.) The Annals of Thoracic Surgery 2013 96, 1390-1397DOI: (10.1016/j.athoracsur.2013.05.004) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Example of the coronary angle measurement on computed tomographic coronary angiography. (A) Measurement of a normal angle of the right coronary artery (RCA) origin (left, axial slice) was confirmed on the three-dimensional view (right). (B) Patient with an acute angle of the circumflex artery (Cx) origin (22 degrees, left, axial slice) was confirmed on the three-dimensional view (right). (Ao = neoaorta; LAD = left anterior descending coronary artery; PT = pulmonary trunk.) The Annals of Thoracic Surgery 2013 96, 1390-1397DOI: (10.1016/j.athoracsur.2013.05.004) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Case examples of patients with abnormal coronary findings on computed tomographic coronary angiography. (A) A significant proximal left anterior descending coronary artery (LAD) stenosis caused by fibrocellular intimal thickening. The stenosis is located close to the ostium (arrow), and a poststenotic dilation can be observed. Axial slice (left); multiplanar reconstruction of the LAD artery (right). (B) Interarterial course of the right coronary artery, coursing between the neoaorta (Ao) and the pulmonary artery (arrow, left), also visible on the sagittal-axis image (white circle, right). (C) Acute angle of the left anterior descending coronary artery (white arrows), possibly causing coronary ostium compression. Axial slice (left); three-dimensional reconstruction (right). (LA = left atrium; LV = left ventricle; PT = pulmonary trunk; RV = right ventricle.) The Annals of Thoracic Surgery 2013 96, 1390-1397DOI: (10.1016/j.athoracsur.2013.05.004) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions