Coronary coding in dTGA pre- and post-ASO - verification and necessary corrections following adult CMR

Abstract

In adult patients with transposition of the great arteries (dTGA) after arterial switch operation (ASO), the coronary artery circulation after neonatal surgical transfer remains a major culprit for long-term sequelae, including myocardial ischemia and sudden cardiac death. As coronary imaging in paediatric age is often incomplete and classification mainly relies on surgeon’s description in the operation report, we intended to develop a systematic, understandable pattern of the coronary status for each young patient, combing unambiguous coding with non-invasive imaging. The monocentric prospective study evaluated 89 young adults (mean 23 years) after ASO for dTGA including cardiac magnetic resonance (CMR) coronary angiography. Following “The Leiden Convention coronary coding system”, we describe the systematic transformation process and provide a graphical illustration considering surgical and imaging views for the 6 main coronary types, followed by comparison with adult CMR. Discordance between surgeon’s and CMR classification is evaluated. In 7 (7.9%) patients, a discordance between the surgeon’s postoperative and the CMR classification was found; therefore, the initial classification had to be corrected according to adult CMR. Three cases (3.4%) with particularly challenging coronary variants (intramural and inter-arterial course, functional common ostium) are presented. Considering the risks of a possible neonatal coronary misclassification and of increasing additional acquired coronary artery disease with age, a reliable cooperation between surgeons, cardiologists and imaging specialists must be ensured. Therefore, after completion of growth, a systematic pattern of the coronary artery status, combing unambiguous coding with CMR imaging, should be established for each patient.