Ismat Fraz A, Baldwin H Scott, Karl Tom R, Weinberg Paul M
Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., PA 19104, USA.
Int J Cardiol. 2002 Dec;86(2-3):207-16. doi: 10.1016/s0167-5273(02)00325-x.
The advent of double switch procedures for the treatment of transposition of the great arteries with L-looped ventricles, e.g. typical congenitally corrected transposition of the great arteries, has made delineation of the coronary artery anatomy in these hearts important. Previous studies have suggested a consistently inverted coronary arterial pattern.
A morphologic study was conducted of the coronary arterial anatomy of all heart specimens in our registry of approximately 2600 hearts with segmental anatomy [S,L,L] (situs solitus of the viscera and atria, ventricular L-loop, and levoposition of the aorta), with anatomical features to permit such repair.
Twenty specimens collected between 1965 and 1993 ranged in age from 1 day to 23 years. Transposition of the great arteries or double outlet right ventricle was seen in 12 (60%). One had a single coronary artery that arose from the right anterior sinus and trifurcated. Another had the anterior descending artery arise from the right ventricular coronary artery while the circumflex arose alone, directly above the intercoronary commissure. Eccentric ostia were seen in another four, with one left ventricular coronary artery originating directly above the intercoronary commissure. Right ventricular aorta with pulmonary atresia was in eight of the total (40%). Three had eccentric ostia: one with both arteries from the left posterior sinus, and one with the left ventricular coronary over the intercoronary commissure. None of these specimens had additional coronary anomalies that would further complicate surgery.
Nearly half of the specimens (45%) had coronary artery abnormalities that could have complicated, but not necessarily precluded, anatomic surgical repair.
用于治疗大动脉转位合并L袢心室（如典型的先天性矫正型大动脉转位）的双调转手术的出现，使得明确这些心脏的冠状动脉解剖结构变得重要。既往研究提示冠状动脉模式始终呈倒置状态。
对我们登记的约2600例具有节段解剖结构[S，L，L]（内脏和心房正位、心室L袢以及主动脉左旋位）且具有允许此类修复的解剖特征的心脏标本的冠状动脉解剖结构进行了形态学研究。
1965年至1993年间收集的20例标本，年龄从1天至23岁不等。12例（60%）可见大动脉转位或右心室双出口。1例有一条起源于右前窦并呈三叉状分支的单一冠状动脉。另1例前降支起源于右心室冠状动脉，而回旋支单独起源于冠状动脉间连合上方。另外4例可见偏心开口，其中1例左心室冠状动脉直接起源于冠状动脉间连合上方。右心室主动脉伴肺动脉闭锁占总数的8例（40%）。3例有偏心开口：1例两条动脉均起源于左后窦，1例左心室冠状动脉位于冠状动脉间连合上方。这些标本均无会使手术进一步复杂化的其他冠状动脉异常。
近半数标本（45%）存在可能使解剖性手术修复复杂化但不一定排除手术的冠状动脉异常。
