Echocardiographic accuracy detection of coronary pattern in D-transposition of the great arteries: 20 years of a single center experience

Abstract Background Preoperative assessment of coronary artery (CA) anatomy in transposition of the great arteries (TGA) remains critical for surgical planning. Echocardiography is the primary imaging modality for preoperative identification of CA patterns. Purpose To evaluate the accuracy of preoperative echocardiographic assessment of coronary anatomy in patients with D-transposition of the great arteries (d-TGA) based on a 20-year institutional experience. Methods A retrospective analysis was conducted on patients with d-TGA who underwent primary arterial switch repair at our institution between January 2004 and April 2024. Echocardiographic findings of coronary artery patterns were compared with intraoperative surgical observations to assess echocardiography diagnostic accuracy. Results A total of 394 patients were included: 274 (70%) had d-TGA with intact ventricular septum, and 120 (30%) had d-TGA with ventricular septal defect. A "usual" coronary pattern was identified in 239 cases (61%), with echocardiographic findings confirmed intraoperatively in 92% of cases (219/239). Unusual coronary patterns were observed in 155 cases (39%), with echocardiography accurately identifying these in 89% of cases (138/155). Coronary anatomy was not successfully delineated preoperatively in 40 cases. The diagnostic accuracy for intramural coronary arteries was 87.5%. Echocardiography demonstrated a sensitivity of 89%, specificity of 92%, and an overall diagnostic accuracy of 91% for coronary pattern identification. Notably, echocardiography successfully identified a previously undescribed coronary variant: a circumflex artery arising from the right coronary artery with a posterior loop, along with a double anterior descending artery originating from the right coronary artery with an anterior loop. Conclusions Echocardiography is a highly reliable modality for preoperative assessment of coronary artery anatomy in d-TGA, including complex and unusual coronary variants. Its high diagnostic accuracy supports its continued role as the primary imaging tool in surgical planning for these patients.