Abstract
Background
There are limited data regarding the influence of commissural malalignment of the aortic-pulmonary sinus on the arterial switch operation.
Objective
To compare diagnostic accuracy between cardiac CT and echocardiography for evaluating commissural malalignment of aortic-pulmonary sinus in children with complete transposition of the great arteries and to seek potential clinical implication of commissural malalignment on the arterial switch operation.
Materials and methods
In 37 patients (35 boys; median age: 8 days, range: 3-80 days) with complete transposition of the great arteries who had tricuspid semilunar valves and underwent an arterial switch operation, the degree of the commissural rotation of the aortic-pulmonary sinus was assessed on cardiac CT (n=37) and echocardiography (n=35). With surgical finding as a reference, cardiac CT was compared with echocardiography in identifying commissural malalignment in 35 patients. The influence of the height difference between the semilunar valves measured by cardiac CT on the identification of commissural malalignment with cardiac CT and echocardiography was evaluated. The impact of commissural malalignment on coronary transfer techniques was evaluated.
Results
In operative findings, the commissures of the semilunar valves were aligned in 24 patients and malaligned in 13. With surgical findings as a reference, cardiac CT showed higher, but not statistically significant (P>0.05), sensitivity (91.7% vs. 75.0%), specificity (87.0% vs. 78.3%) and accuracy (88.6% vs. 77.1%) for the diagnosis of the malalignment than echocardiography. The measured height difference between the semilunar valves did not affect the identification of the malalignment with cardiac CT and echocardiography. The surgical malalignment group showed a higher requirement of modified coronary transfer techniques than the surgical aligned group (11/13 vs. 11/24, P=0.03).
Conclusion
Cardiac CT and echocardiography appear useful for evaluating commissural malalignment of the semilunar valves in patients with complete transposition of the great arteries frequently requiring modified coronary transfer techniques at during an arterial switch operation.
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References
Wernovsky G, Mayer JE Jr, Jonas RA et al (1995) Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 109:289–301
Losay J, Touchot A, Serraf A et al (2001) Late outcome after arterial switch operation for transposition of the great arteries. Circulation 104:I121–I126
Legendre A, Losay J, Touchot-Koné A et al (2003) Coronary events after arterial switch operation for transposition of the great arteries. Circulation 108:II186–II190
Brown JW, Park HJ, Turrentine MW (2001) Arterial switch operation: factors impacting survival in the current era. Ann Thorac Surg 71:1978–1984
Kim SJ, Kim WH, Lim C et al (2003) Commissural malalignment of aortic-pulmonary sinus in complete transposition of great arteries. Ann Thorac Surg 76:1906–1910
Anderson RH, Becker AE (1981) Coronary arterial patterns: a guide to identification of congenital heart disease. In: Becker AE, Losekoot G, Anderson RH (eds) Pediatric cardiology, 3rd edn. Churchill Livingstone, Edinburgh, pp 251–262
Stoica S, Carpenter E, Campbell D et al (2012) Morbidity of the arterial switch operation. Ann Thorac Surg 93:1977–1983
Duncan WJ, Freedom RM, Rowe RD et al (1981) Echocardiographic features before and after the Jatene procedure (anatomical correction) for transposition of the great vessels. Am Heart J 102:227–232
Goo HW (2012) CT radiation dose optimization and estimation: an update for radiologists. Korean J Radiol 13:1–11
Chiu IS, Chu SH, Wang JK et al (1995) Evolution of coronary artery pattern according to short-axis aortopulmonary rotation: a new categorization for complete transposition of the great arteries. J Am Coll Cardiol 26:250–258
Yamaguchi M, Hosokawa Y, Imai Y et al (1990) Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan. J Thorac Cardiovasc Surg 100:261–269
Massoudy P, Baltalarli A, de Leval MR et al (2002) Anatomic variability in coronary arterial distribution with regard to the arterial switch procedure. Circulation 106:1980–1984
Goo HW, Yang DH (2010) Coronary artery visibility in free-breathing young children with congenital heart disease on cardiac 64-slice CT: dual-source ECG-triggered sequential scan vs. single-source non-ECG-synchronized spiral scan. Pediatr Radiol 40:1670–1680
Goo HW (2015) Coronary artery imaging in children. Korean J Radiol 16:239–250
Goo HW, Seo DM, Yun TJ et al (2009) Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multi-slice CT findings. Pediatr Radiol 39:265–273
Yu FF, Lu B, Gao Y et al (2013) Congenital anomalies of coronary arteries in complex congenital heart disease: diagnosis and analysis with dual-source CT. J Cardiovasc Comput Tomogr 7:383–390
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Bang, J.H., Park, JJ. & Goo, H.W. Evaluation of commissural malalignment of aortic-pulmonary sinus using cardiac CT for arterial switch operation: comparison with transthoracic echocardiography. Pediatr Radiol 47, 556–564 (2017). https://doi.org/10.1007/s00247-017-3786-0
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DOI: https://doi.org/10.1007/s00247-017-3786-0