P4375Value of echocardiography to diagnose coronary arteries patterns in transposition of great arteries

Abstract The objective of this study was to evaluate the accuracy of echocardiographic to assess coronary arteries (CA) anatomy in transposition of the great arteries (TGA) and determine impact on outcomes. Material and methods Retrospective analysis of data in neonates diagnosed with TGA (isolated or associated with VSD). Preoperative echocardiographic (TTE) coronary artery pattern and surgical intraoperative reports (SURG) were compared. Mismatch between TTE and SURG, and its impact on perioperative outcome were assessed. Coronary patterns were classified in 4 groups: I= normal CA, II= CA with intramural course, III= CA loop, IV= CA loop and intramural segment. Results 108 neonates who underwent arterial switch operation (ASO) for isolated TGA (67 cases) or TGA+VSD (41) were included in the study: 68 ranged in group I, 7 in group II, 32 in group III and 1 in group IV. Five patients died (4.6%), from coronary cause in 3. Survival rates were 96% at 1-month and 95.2% beyond. Intraoperative complications occurred in 10 cases. TTE and SURG CA diagnosis differed in 19 cases = 17.6% (mismatch). Diagnosis of CA anatomy differed in 4.4%, 42.8%, 37.5% and 100% of respectively groups I, II, III and IV. Mortality was 28.6% in group II (intramural CA) compared to 2.9% in group I, 3.1% in group III and 0% in group IV (p=0.002). Death rates was 15.8% if TTE/SURG mismatch and 2.2% if TTE and SURG were concordant (p=0.0108). Mortality in group II (intramural CA) increased up to 50% in case of mismach TTE/SURG versus 0% if concordance, and was similar in the other groups. Survival rates were 84.2% in TTE misdiagnosed CA anomalies compared to 97.6% if TTE assessment correlated with surgical reports. By multivariate analysis, groups II and III coronary anatomy were risk factors for mismatch between TTE and SURG (respectively p=0.008 and p=0.0005), and mismatch TTE/SURG was the only risk factor for perioperative mortality (p=0.045). Conclusion Echocardiography can accurately assess coronary artery anatomy in neonates with TGA. Intramural coronary course is often misdiagnosed. Missed diagnosis of coronary artery anomaly preoperatively may impact on perioperative mortality.