Evaluation of coronary arterial patterns in complete transposition by laid-back aortography

Abstract

AbstractFor the visualization of the coronary arterial patterns in complete transposition (concordant atrioventricular and discordant ventriculoarterial connections), balloon occlusion aortography has been performed in right and left anterior oblique or in frontal and lateral views. These views, however, are often unsatisfactory because of super-imposition of the aortic sinuses. The so-called “laid-back” view is a newly developed angiographic projection in which the aortic sinuses and the intervening commissures are imaged as if they were seen from below and the front. We performed such laid-back aortography in 36 consecutive patients with an echocardiographic diagnosis of complete transposition. In 23 of 36 patients, we obtained additional aortograms in right and left anterior oblique views. For the evaluation of the diagnostic value of the laid-back view, as compared with that of the combined right and left anterior oblique views, both sets of aortograms were reviewed independently by the five reviewers who were asked to make a diagnosis and to specify their levels of confidence (“definite,” “probable,” and “possible”) for their diagnosis. Error rates were significantly lower for the laid-back aortograms than for the combined right and left aortograms (4 and 11%, respectively). An increased level of confidence was significantly associated with the laid-back aortograms. We illustrate the anatomy of various coronary arterial patterns seen by laid-back aortography.