Pattern of Coronary Arteries Anatomy in DTGA and its Impact on Surgical Outcome

Background: D-Transposition of the Great Arteries (DTGA) is a congenital heart defect characterized by a reversal in the origin of the great arteries. The aorta rising from the right ventricle and pulmonary artery from the left ventricle. This anomaly leads to a unique circulatory pattern where oxygen-poor blood is circulated to the body, and oxygen-rich blood is cycled back to the lungs. The coronary anatomy in DTGA patients is quite variable. The aberrant coronary patterns associated with DTGA add a layer of complexity to surgical interventions, during arterial switch operation. of the Great Arteries. Objectives: To systematically analyze the pattern of coronary artery anatomy in patients with DTGA and assess their impact on surgical procedure and outcome. Methods: This retrospective, single-center study is conducted at Prince Sultan Cardiac Center, Riyadh, Saudi Arabia. Medical records from January 2017 to December 2023 have been reviewed, including patient demographics, coronary arteries anatomy, surgical procedures, and post-operative outcomes. The cohort included all patients diagnosed with DTGA who underwent arterial switch operation (ASO) within the first four months of life. DTGA patients who did not qualify for arterial switch operation were excluded. Descriptive and inferential statistical methods were used to analyze the data. Results: A total of 104 patients were included in the study analysis. The mean age of the patients was 23.5 days, and the average weight was 3.21 kg. The gender distribution was 62.5% male and 37.5% female. Majority of patients (64.4%) had DTGA with Intact Ventricular Septum (IVS), while 35.6% had DTGA with Ventricular Septal Defect (VSD). The usual pattern of coronary arteries Left coronary artery (LCA=LAD +LCX) from sinus 1and RCA from sinus 2, was observed in 65.4% of patients. Other variations in the coronary anatomy were found as follows: a-LAD from sinus 1, and origin of the circumflex artery (LCX) from the right coronary artery from sinus 2 in 22.1% of patients. b-Single left coronary artery in 6, c-single right coronary artery in 8 patients. Intramural LAD is found in 2 patients, one of them was diagnosed preoperatively while, it was discovered intraoperatively in one patient who needed ECMO support and died after 72 hours. The mean cross-clamp time was 124.04 minutes, and the mean post-operative ICU stay was 15.2 days. Conclusion: The study highlights the importance of understanding coronary artery patterns in DTGA patients for surgical planning and optimizing post-operative outcomes. Despite limitations due to the retrospective single-center design, the study provides valuable insights into the clinical management of DTGA and emphasizes the need for individualized surgical strategies in patients with unusual coronary anatomy.