https://orcid.org/0000-0003-4886-4767
-
Views
-
Cite
Cite
Lisheng Lin, Haruo Ohtani, Junko Shiono, Micropathological visualization of left coronary artery intramural course in complete transposition of the great arteries: a pathological perspective with surgical implications, European Heart Journal, Volume 46, Issue 18, 7 May 2025, Page 1772, https://doi.org/10.1093/eurheartj/ehaf092
Close - Share Icon Share
Extract
A male infant, prenatally diagnosed with complete transposition of the great arteries and a ventricular septal defect, was born at 38 weeks’ gestation. Coronary artery evaluation revealed both the right (RCA) and the left coronary arteries (LCA) originating from the posterior sinus (sinus 2) with separate ostia. The LCA coursed between the aorta and pulmonary artery, corresponding to Shaher type 5A1 (Panel A1-2); therefore intramural LCA complication was considered highly possible, making the arterial switch operation (ASO) challenging. The patient developed necrotizing enterocolitis while awaiting the ASO and died at 38 days old despite intensive management.
Postmortem autopsy demonstrated that both coronary ostia in sinus 2 were adjacent, with the LCA ostium being significantly smaller (Panel B1-2). Microscopically, the RCA arose perpendicularly from the aortic wall, while the LCA followed an oblique intramural course within the aortic wall. These findings highlight the complexity of coronary button harvesting (Panel C1-2). Although surgical techniques have been devised to graft coronary arteries with an intramural course,2 in practice, the procedure involves making incisions in areas of the coronary artery that are not directly visible. In the present case, the cutback distance of the inner wall from the original LCA ostium to unroof the intramural artery was approximately 2 mm. The parallel course of the LCA to the aortic wall suggests a high risk of bending or obstruction during reattachment.
