Selective anterograde coronary arteriography in neonates with d-transposition of the great arteries: accuracy and safety.
OBJECTIVE
This study was designed to evaluate the accuracy and safety of selective anterograde coronary arteriography for the identification of the origin and branching pattern of the three main coronary arteries in neonates with d-transposition of the great arteries.


BACKGROUND
Definition of coronary artery anatomy is important in neonates with d-transposition of the great arteries who are considered for the arterial switch operation. Balloon occlusion aortography defines coronary artery anatomy in most but not all cases. We have described a technique for selective anterograde coronary arteriography.


METHODS
Between March 1987 and May 1991, 17 neonates underwent selective anterograde coronary arteriography and 29 patients had balloon occlusion aortography. After venous access was gained, a mesenteric catheter was used to engage the coronary ostia for contrast injection. All angiograms were reviewed by three independent observers and the coronary artery diagnoses were compared with operative findings. Complications with the catheterization procedure were also recorded.


RESULTS
The accuracy of defining coronary artery anatomy with selective anterograde coronary arteriography (98 +/- 2%) was significantly (p < 0.05) greater than that achieved with balloon occlusion aortography (69 +/- 6%). There were no deaths with catheterization in either study group. Morbidity was similar in the groups with balloon occlusion aortography (7%) and selective anterograde coronary arteriography (6%) (p > 0.05) and was related to transient bradycardia induced by catheter manipulation in the right ventricle. No patient in either study group experienced cardiac ischemia.


CONCLUSIONS
Selective anterograde coronary arteriography is an accurate and safe technique for the definition of coronary artery pattern in neonates with d-transposition of the great arteries.
Allada
V
V
Department of Pediatrics, University of California, Los Angeles 90024.
Jarmakani
J M
JM
Day
R W
RW
Galindo
A
A
Isabel-Jones
J B
JB
D001027:Aortography / Q000379:methods; D003287:Contrast Media; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D003331:Coronary Vessels / Q000473:pathology*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011300:Preoperative Care; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging*
D003287:Contrast Media