Diagnostic performance of echocardiography for preoperative coronary artery assessment in infants with transposition physiology (transposition of the great arteries and DORV-TGA): A CT angiography comparative study

BACKGROUND: TGA accounts for 5-7% of congenital heart disease, with a prevalence of 0.2 per 1000 live births. The Modified Leiden Convention provides a standardized nomenclature for describing coronary artery anatomy across imaging and surgical practice. A thorough understanding of coronary artery anatomy is essential for planning the arterial switch operation as it is the established treatment for infants with TGA. METHODS: Our study was a cross-sectional study which included 62 infants (<6 months) diagnosed with TGA or TGA-type DORV. Origin of the coronary artery anatomy was classified using the Modified Leiden Convention. Interpretation of findings were performed independently by experienced observers who were blinded to the findings of the other modality. CT angiography was considered the reference standard. Sensitivity, specificity, predictive values, diagnostic accuracy, and agreement (Cohen's kappa) were calculated. RESULTS: CT angiography identified usual coronary anatomy in 33 patients (53.2%) and variant patterns in 29 patients (46.8%) among the 62 infants. Echocardiography demonstrated a sensitivity of 84.8% and a specificity of 31.0% in diagnosing usual coronary artery anatomy. The positive predictive value for usual anatomy was 58.3%, and the negative predictive value was 64.3%. Echocardiography demonstrated a sensitivity of only 31.0% and a specificity of 84.8% in demonstrating variant anatomy. CONCLUSION: Echocardiography accurately identified the usual coronary artery pattern but had limited sensitivity for coronary variants. CT angiography is a valuable complementary tool when echocardiographic findings are inconclusive or complex anatomy is suspected before arterial switch surgery.