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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 572-583, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Infundibular septum and coronary anatomy in Jatene operation

H Kurosawa, Y Imai, Y Takanashi, S Hoshino, K Sawatari, M Kawada and A Takao

Displacement of the infundibular septum and coronary anatomy was studied in 40 patients with variable transposition of the great arteries who underwent the Jatene operation between August, 1982, and May, The perioperative mortality was 12.5%. Fourteen of the 16 patients (87.5%) with intact ventricular septum (Group I), eight of the 12 patients (67%) with aligned infundibular septum and perimembranous trabecular defect (Group II-A), and four of the 12 patients (33%) with anteriorly displaced infundibular septum, malaligned defect, overriding of the pulmonary valve, and severe pulmonary hypertension (Group hypertension (Group II-B) has Shaher type 1 coronary anatomy. In this type of coronary anatomy, the left coronary artery courses in front of the pulmonary artery. However, two patients (12.5%) from Group I, four (33%) from Group II-A, and eight (67%) from Group II-B had various unusual coronary patterns, such as Shaher types 2,3,4,7, and 9. All patients had a left or circumflex coronary artery coursing behind the pulmonary artery. These data suggest that the displacement of the infundibular septum not only determines the type of the defect and hemodynamics, but also often relates to the coronary anatomy Removal of a whole, scallop-shaped sinus of Valsalva and minimal dissection of the coronary artery are preferable, particularly for translocation of such unusual coronary anatomy.

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