Commissural Malalignment as a predictor of coronary artery abnormalities in patients with transposition of great arterie
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(2020) 4:7
RESEARCH ARTICLE
Journal of Congenital Cardiology
Open Access
Commissural Malalignment as a predictor of coronary artery abnormalities in patients with transposition of great arteries Mohamed Al Nasef1,2 , Mohammed H. Alghamdi1,3, Maria L. Bello Valls1, Ahmed M. Zahrani4, Ali AlAkfash5, Husam I. Ardah6,7, Obayda M. Diranneya1 and Fahad Alhabshan1,6,7*
Abstract Background: In patients with transposition of the great arteries (TGA), commissural malalignment (CM) between semilunar valves may be associated with abnormal coronary (CA) pattern. We intend to assess the degree of CM with incidence of unusual CA anatomy. Methods: We proposed a ratio to measure the distance of both ends of the anterior facing sinuses of the pulmonary valve from the facing commissure of the aortic valve. We labeled it as D1 and D2 distance. A ratio (C ratio) of the smaller distance (either D1 or D2 whichever is shorter) over the sum of both D1 and D2 was taken (D1 or D2 whichever is shorter / D1 + D2). We related this ratio with the incidence of the unusual CA anatomy in D-TGA patients. Results: We had a total of 158 patients. We defined the point beyond which the C-Ratio becomes significantly associated with abnormal coronary artery pattern, this represents the median effective level (EL50). The EL50 of the C-Ratio was found to be equal to 31% (0.31). The prediction revealed that the CA pattern would most probably be usual when there is a minor commissural malalignment (C-Ratio less than the EL50) and most probably be unusual when there is a major malalignment (C-Ratio is greater than the EL50). The sensitivity was 71% and the specificity 88% (p-value < 0.0001). Conclusions: The C-Ratio helps to categorize the degree of CM as minor (less than 0.31) or major (more than 0.31). A higher C-Ratio predicts a higher incidence of unusual CA pattern. Keywords: Transposition of great arteries, Commissural malalignment, Coronary abnormality, Arterial switch operation
* Correspondence: [email protected] 1 Cardiac Sciences Department, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia 6 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a co
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