2022 AMI Online Salon

Origin of Coronary Arteries in ccTGA

Project Details

  • Entrant Name:  Mica Duran
  • Client: Anatomize Medical Media Inc
  • Copyright: ©2021 STS – Society of Thoracic Surgeons, 2021
  • Medium/software used: Adobe Photoshop
  • Final presentation format: e-Textbook
  • Primary Audience: Cardiac Surgeons

Project Description

The purpose of the illustration is to provide surgeons with a visual convention to determine the origin of the coronary arteries in congenitally corrected transposition of the Great Arteries (ccTGA). With ccTGA, the usage of “left” and “right” can be confusing for anatomic sidedness versus intrinsic morphologic nature.For the most common coronary pattern in ccTGA with a leftward/anterior aorta, sinus #1 (right-hand sinus), which is anatomically the leftward and posterior sinus, gives origin to the right coronary artery; and sinus #2 (left-hand sinus), which is rightward and anterior, gives origin to the main stem of the left coronary artery. The anatomic right-sided coronary artery is therefore a morphologic left coronary artery, with a short main stem dividing into the anterior descending and circumflex coronary arteries. The anatomic left-sided coronary artery is therefore a morphologic right coronary artery. By depicting the surgeon standing within the non-adjacent aortic sinus with a view toward the pulmonary trunk, the surgeon observes the morphologic right coronary artery arising on his right-hand side; and the morphologic left coronary artery arising on his left-hand side.The overhead orientation also provides visualization of the abnormal connection of the great arteries — with the aorta originating from the morphologic right ventricle (mRV), and the pulmonary artery from the morphologic left ventricle (mLV). The use of color was limited to focus the viewer.