4. CORONARY ANATOMY IN TGA
Leiden convention classification system
• The most frequently seen anatomy is the left
coronary artery from sinus 1 and the RCA from
sinus 2 (62.5%). The second most common
type is the RCA and is circumflex from sinus 2
and the LAD from sinus 1 (22%). These two
patterns describe over 85% of the coronary
artery reported possibilities described for TGA.
5.
6.
7.
8. YACOUB AND ROSEMARY RADLEY-
SMITH
• In type A the right and left coronary ostia arise from the
middle of the right and left posterior aortic sinuses and curve
forwards to reach the right atrioventricular groove or anterior
interventricular groove respectively.
9. • In type B both coronary arteries arise by a
single ostium
10. • Intype C the two coronary ostia are situated
posteriorly, very close to each other, in a
position similar to that in type B.
11. • in type D the origin of the coronary arteries is similar to that
of type A. However, the right coronary artery gives origin to
the circumflex coronary artery that curves round the posterior
(pulmonary) vessel to reach the atrioventricular groove.
12. • In type E the right coronary artery arises in common with the
left anterior descending artery from the left posterior
sinus, while the circumflex artery arises separately from the
right posterior sinus.
16. Van Praagh and van Praagh
• A1 corresponds to type I of Collett and Edwards, and
• type A2 encompasses types II and III (Fig. 44.2).
• Type A3 includes cases with absence of truncal origin
of one pulmonary artery, with blood supply to that
lung from the ductus arteriosus or from a collateral
artery.
• Last, type A4 is associated with underdevelopment of
the aortic arch, including tubular hypoplasia, discrete
coarctation, or complete interruption
• The Van Praagh classification also specifies the
presence of a VSD (type A), or the absence of a VSD
(type B).
17. DORV
• The classification focuses on the location of
the VSD relative to the great arteries and the
great artery relationships—
Relationship of the Great Arteries
• Four types of great artery relationships (Fig.
53.1) at the level of the semilunar valves have
been described in DORV
18. • Right posterior aorta-- The aortic valve and trunk originate
from the right ventricle at a location posterior and to the
right of the pulmonary valve and its arterial trunk.
• Right lateral aorta (side-by-side relationship)-- The aorta is
to the right of the pulmonary artery, and the semilunar
valves lie approximately in the same transverse and coronal
plane. This is the classically described great artery
relationship in DORV.
• Right anterior aorta-- The aorta is to the right and anterior
to the pulmonary artery. This grouping also may include
some cases with the aorta directly anterior.
• Left anterior aorta-- The aorta is to the left and anterior to
the pulmonary artery. This group also may include some
cases with the aorta nearly entirely to the left of the
pulmonary artery, or in a side-by-side relationship, or left
lateral.
19. Position of the Ventricular Septal Defect
There are four types of VSDs in DORV
• The subaortic type. The VSD is located anatomically closer
to the aortic valve than to the pulmonary valve.
• The subpulmonary type. The VSD is located closer to the
pulmonary valve. This occurs when the VSD is located
above the septal limb of the crista supraventricularis
(supracristal VSD). This type of DORV is synonymous with
the Taussig - Bing complex.
• The doubly committed, or subaortic and
subpulmonary, type. The VSD is very large and is closely
related to both semilunar valves.
• The remote type. The VSD is distant from both semilunar
valves and may represent a posterior VSD, an AV defect
type, or an isolated muscular VSD.
29. • Interrupted, or congenitally absent, aortic arch is
defined as a complete separation of ascending
and descending aorta
• Celoria and Patton (74) classified these as—
• type A if the interruption was distal to the left
subclavian artery,
• type B if between carotid and subclavian arteries,
and
• type C if between carotid arteries.
30. • further subcategorized (75) and definitions generalized to include
both right and left arch patterns as follows:
• Interruption distal to that subclavian artery that is ipsilateral to
second carotid artery (i.e., if first carotid is right, interruption distal
to left subclavian artery)
– Without retroesophageal or isolated subclavian artery
– With retroesophageal subclavian artery
– With isolated subclavian artery
• Interruption between second carotid and ipsilateral subclavian
artery
– Without retroesophageal or isolated subclavian artery
– With retroesophageal subclavian artery (i.e., both carotid arteries
proximal, both subclavians distal) (Fig. 36.19A)
– With isolated subclavian artery
• Interruption between carotid arteries
– Without retroesophageal or isolated subclavian artery
– With retroesophageal subclavian artery
– With isolated subclavian artery
