J Korean Soc Radiol.  2016 Jul;75(1):62-67. 10.3348/jksr.2016.75.1.62.

An Unreported Type of Coronary Artery Anomaly in Congenitally Corrected Transposition of Great Arteries

• Kwak MK
• Jeong YJ
• Lee G
• Lee NK
• Choi JH
• Lee JW

• KMID: 2327369
• DOI: http://doi.org/10.3348/jksr.2016.75.1.62

Abstract

Coronary artery variations are associated anomalies in 45% of congenitally corrected transposition of the great arteries (ccTGA) cases, and it is important to detect any coronary artery anomalies before cardiac surgery. We report a case of a 51-year-old woman with ccTGA and an unreported type of coronary artery anomaly.

MeSH Terms

Arteries
Congenital Abnormalities
Coronary Artery Disease
Coronary Vessels*
Female
Heart
Humans
Middle Aged
Multidetector Computed Tomography
Thoracic Surgery
Transposition of Great Vessels*

Figure

• 

  Fig. 1 An unreported type of coronary artery anomaly in congenitally corrected transposition of great arteries. A. Axial CT image shows the aorta anterior to and left of the pulmonary trunk, suggestive of levo-transposition of the great vessels. B. Axial CT image shows that the left-sided AV valve (black arrowhead) lies closer to the apex than does the right-sided AV valve (white arrowhead). A moderator band (arrow) and prominent trabeculation are seen in the left-sided ventricle. C. The three-chamber view of the left-sided ventricle shows a tricuspid-aortic fibrous discontinuity (black arrow) caused by the presence of the right ventricular infundibulum (left). The three-chamber view of the right-sided ventricle shows mitral-pulmonary fibrous continuity (right). Ao = aorta, AV = atrioventricular, CT = computed tomography, LA = left atrium, LV = morphological left ventricle, PA = pulmonary artery, RA = right atrium, RV = morphological right ventricle D. Oblique axial MIP and 3D VR images show coronary arteries arising from three separate coronary ostia. A stair-step artifact (*) resulting from the irregular heart rhythm in the proximal segment of the circumflex artery arising from the anterior right sinus is also seen. The aortic valve has three cusps, which are located to the left anteriorly, right anteriorly, and posteriorly. The right ventricular branch (white arrowhead), which runs along the wall on the morphological right ventricle, originates from the anterior left sinus. The circumflex and anterior descending arteries arise from one ostium (black arrow) of the anterior right sinus. The right ventricular artery (white arrow) originates from the other ostium of the anterior right sinus. Another right ventricular branch (black arrowhead) originates from the posterior sinus. E. Axial MIP and 3D VR images show the right ventricular artery arising from the anterior right sinus traveling along the left AV groove with a retropulmonary course (white arrow). al = anterior left sinus, ar = anterior right sinus, CT = computed tomography, LA = left atrium, LV = morphological left ventricle, MIP = maximum intensity projection, p = posterior sinus, PA = pulmonary artery, RA = right atrium, RV = morphological right ventricle, 3D VR = 3D dimensional volume-rendered

• 

  Fig. 2 Diagrams of the coronary anatomy showing our case and typical ccTGA. Dashed lines represent variably present branches. ccTGA = congenitally corrected transposition of the great arteries

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