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Relationship between orifices of pulmonary and coronary arteries in common arterial trunk

^a Cardiac Morphology Unit, National Heart & Lung Institute, Guy Scadding Building, Imperial College London, Dovehouse Street, London SW3 6LY, UK
^b Department of Cardio-Thoracic Surgery, Royal Brompton Hospital, UK
^c Department of Paediatric Cardiology, Royal Brompton Hospital, UK

Received 18 November 2008; received in revised form 20 December 2008; accepted 30 December 2008.

^_* Corresponding author. Tel.: +44 20 7351 8751; fax: +44 20 7351 8230. (Email: yen.ho{at}imperial.ac.uk).

Objective: Variability in pulmonary arterial and coronary arterial origins in common arterial trunk has been investigated previously but only as separate entities. We hypothesise that combinations of relationships between the two arterial structures have important clinical implications. Methods: We identified pulmonary arterial and coronary arterial origins in 56 heart specimens. The orifices were plotted according to the location on the circumference of the common trunk and distance from the level of the sinutubular junction. Results: Pulmonary orifice was sinusal when the lowest margin of the orifice was below the sinutubular junction (n = 12, 21%). It was defined as low when located 2 mm above the sinutubular junction (n = 11, 20%). Pulmonary origin >2 mm above the sinutubular junction was designated as normal (n = 33, 59%). Circumferentially, there was a distinct predilection for sinusal origin to be located within the left-anterior segment of the common trunk, as opposed to low and normal origins that almost always resided within the left-posterior segment. Furthermore, hearts with sinusal origin (75%; 9 hearts out of 12) had significantly higher prevalence of proximity (defined as a distance of 2 mm) between pulmonary and coronary orifices than those with low origin (27%; 3 hearts out of 11) and normal origin (3%; 1 heart out of 33) (p = 0.039 and p < 0.001, respectively). Conclusions: Owing to its unique location, frequently close to a coronary orifice, hearts with sinusal origin warrant special attention in both diagnostic and surgical management. At the same time, however, its peculiar pulmonary arrangement may facilitate direct right ventricular-pulmonary connection and dispense with the need for augmentation with an external conduit that inevitably will be outgrown by the patient.

Key Words: Congenital heart disease • Common arterial trunk • Anatomy