Abnormal coronary pattern may complicate coronary transfer during arterial switch operation.

The objective of this study was to evaluate the accuracy of echocardiographic to assess coronary arteries anatomy in transposition of the great arteries and determine impact on outcomes.

Retrospective analysis of data in neonates with transposition of the great arteries. Preoperative echocardiographic coronary artery pattern and surgical intraoperative reports were compared. Mismatch between transthoracic echocardiography and surgical intraoperative reports, and its impact on perioperative outcome were assessed. Coronary patterns were classified in 4 groups: I=normal, II=coronary with intramural course, III=CA loop.

One hundred and eight neonates who underwent arterial switch operation were included: 68 ranged in group I, 7 in group II, 32 in group III and 1 in group II+III. Intraoperative complications occurred in 10 cases. Five patients died, from coronary cause in 3 (Table 1). Survival rates were 96% at 1-month. Transthoracic echocardiography and surgical intraoperative reports differed in 17.6%. Death rates were 15.8% in case of inappropriate diagnosis and 2.2% if the diagnosis was appropriate (P=0.0108) (Fig. 1). Mortality in group II increased up to 50% in case of inappropriate diagnosis versus 0% if concordance. By multivariate analysis, an inappropriate preoperative transthoracic echocardiography diagnosis of coronary pattern was the only significant risk factor for mortality (P=0.04).

Echocardiography can assess coronary artery anatomy in neonates with transposition of the great arteries. Intramural coronary course is often misdiagnosed. Missed diagnosis of coronary artery anomaly preoperatively may impact on perioperative mortality.