A Computed Tomography Study Of Coronary Arteries In Adult Mustard Patients : Anatomy and Clinical Implications

  • Dr Simona Marcora, Bambino Gesł Pediatric Hospital, Pediatric Cardiology Department , Rome, Italy
  • Dr Salvatore Giannico, Bambino Gesł Pediatric Hospital , Pediatric Cardiology Department , Rome, Italy
  • Dr Alberto Bellelli, Fatebenefratelli Isola Tiberina Hospital , Radiology Department , Rome, Italy
  • Dr Marco Pierleoni, Fatebenefratelli Isola Tiberina Hospital , Radiology Department , Rome, Italy
  • Prof Stephen Sanders, Bambino Gesł Pediatric Hospital, Pediatric Cardiology Department , Rome, Italy
  • Dr Paolo Di Renzi, Fatebenefratelli Isola Tiberina Hospital , Radiology Department , Rome, Italy

    • OBJECTIVE. Little is known about coronaries in adult patients (pts) after Mustard operation for TGA. We want to determine coronary anatomy in adult Mustard pts using computed tomography (CT).
    METHODS. A retrospective ECG gating 64-multislice CT (64-MSCT) examination was performed for ventricular function evaluation in 26 Mustard pts (22±3 years) not suitable for cardiac magnetic resonance because of a pacemaker.Two observers independently described origin, epicardial course and size of the major coronary vessels .
    RESULTS.64-MSCT identified origin and course of the coronary arteries in all pts. The coronary origins were usual for TGA in 17 pts (65%) and unusual in 9 pts. The left coronary system was hypoplastic in most pts: the left main coronary artery (LMCA) absent or short in 17/26 pts and the left circumflex coronary artery (LCx) hypoplastic in 17/26 pts (diameter range 0.7-1.2 mm). An inter-arterial course of the LMCA reported to be associated to sudden death and a course of a LCx very close to a caval baffle stent that could complicate an interventional procedure were observed in 2 pts. The diagnoses were totally concordant between the 2 operators.
    CONCLUSIONS. 64 MSCT is an excellent non-invasive technique for studying coronary anatomy in adult pts after Mustard and can show potentially dangerous coronary courses. Interestingly the left coronary system was hypoplastic in the majority of our Mustard pts and could cause ischemic injury to the left ventricle (LV) such as fibrosis and myocardial dysfunction, with important implications for late LV retraining or biventricular resynchronization.