In L TGV ventricles are Inverted . Since , coronary arteries go with the respective ventricle , LAD originates from Right sinus , and RCA arises from Left sinus . (Complex anomalies in origin, course still possible ) LAD supplies venous ventricle . RCA supplies systemic ventricle .
The most surprising Irony is that major epicardial branches run in their respective grooves in the bulk of the patients with L TGV .The LAD runs in anterior interventricular groove and LCX in left AV groove etc. (That’s real power of nature , these epicardial branches home in to their grooves even in the midst of bizarre AV and VA connection !)
Here is the the ultimate reference article ; A study from 255 hearts with C TGV . I wonder , we will never get a study like this !
Questions to ponder
- Is RCA blood flow adequate to support systemic ventricle ?
- If this RCA is a non dominant one what happens to this ventricular function ?
Implication in surgery
Progressive RV dysfunction is a major determiant of long term outcome . Unless we do an arterial switch diverting respective ventricular flow it is not going to help much in the long term