Commissural malalignment on echocardiography as a predictor of coronary artery abnormalities in newborns with transposition of great arteries.

Introduction and objectives: This study evaluated commissural malalignment on echocardiography as a predictor of coronary anomalies.

Methods: All newborns diagnosed with transposition of great arteries in the pediatric cardiac intensive care unit between 1 August 2020 and 1 February 2022 were included in this study. The ratio of distances (C-ratio) from the anterior commissure to the right-sided commissure of the pulmonary valve and the distance from the anterior commissure to the left sided commissure of the pulmonary valve were calculated. According to the median effective level (EL50), it was classified as minor alignment or malalignment (C-ratio ≤EL50) or major malalignment((C-ratio>EL50). Preoperative classification results were compared with the intraoperative coronary anomalies defined by the surgeon.

Results: A total of 60 cases were included in the study. Echocardiography revealed 16/38 (42%) commissural malalignment in the patient group with the usual coronary artery pattern and 15/22 (68%) in the patients with abnormal coronary artery patterns. The median commissural rotation angle was 28 ° (IQR 20-42). Although it was associated with the commissural malalignment (cut-off 30 °,sensitivity 80% and specificity 85%, p=0.001),the commissural rotation angle was unrelated to the presence of a coronary artery anomaly. The C-ratio was 42%(0.42) according to the median effective level. Abnormal coronary artery pattern was more common in patients with major malalignment(C-ratio>0.42) (Sensitivity 82% and specificity 88%,p=0.003).

Conclusion: The incidence of coronary artery anomalies in patients with transposition of great arteries increases with major commissural malalignment. A high C-ratio might be a predictor of coronary artery anomaly.