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J Thorac Cardiovasc Surg 1996;111:988-997
© 1996 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

THE CORONARY ARTERIES IN HEARTS WITH DISCORDANT ATRIOVENTRICULAR CONNECTIONS

Supported in part by the British Heart Foundation and the Joseph Levy Trust (R.H.A.) and by the Endowment Fund of The Royal Liverpool Children's Hospital (A.S.).

Received for publication March 9, 1995 Accepted for publication July 27, 1995. Address for reprints: A. Smith, PhD, FIBMS, Department of Anatomy, Institute of Child Health, Royal Liverpool Children's Hospital Alder Hey, Eaton Road, Liverpool, L12 2AP, England.

Abstract

Gross morphologic study of 14 hearts with congenitally corrected transposition or discordant atrioventricular connections and double-outlet right ventricle or pulmonary atresia disclosed consistently the origins of the coronary arteries from two aortic sinuses. With usual atrial arrangement, the artery arising in sinus 1 (right-hand facing), as seen from the noncoronary aortic sinus, supplied the morphologically right ventricle. Coronary blood supply to the morphologically left ventricle usually came from sinus 2 (left-hand facing), although in two hearts the circumflex branch was a continuation of the artery from sinus 1. The sinus nodal artery arose from the circumflex coronary artery, and histologic studies of two hearts demonstrated that blood supply to the anterior atrioventricular node also came from this vessel. Early branching and entrapment in fat or right ventricular muscle, as well as malalignment of aortic and pulmonary sinuses, occurred frequently. These findings may have implications for coronary arterial transfer in the double switch operation in hearts with discordant atrioventricular connections. (J THORACCARDIOVASCSURG1996;111:988-97)

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