Anomalies of coronary arteries in tetralogy of Fallot: Evaluation on multidetector CT angiography using dual‐source scanner

Abstract

Objectives: The present study sought to determine the prevalence and evaluate the patterns of various anomalies of coronary arteries in patients with tetralogy of Fallot (TOF) on multidetector CT angiography using a dual-source CT scanner.Methods: We retrospectively reviewed CT angiographies of 955 pediatric patients, diagnosed with TOF between 1st January 2015 and 31st December 2019 and having an optimal evaluation of coronary arteries, with respect to the origin, course, and termination of the coronary arteries and associated cardiovascular anomalies.Results: Anomalies of coronary arteries were observed in 8.27% (79/955) patients with TOF. Origin of accessory/proper left anterior descending (LAD) artery from right coronary artery (RCA) or right coronary sinus was the most common anomalous pattern, seen in 3.14% (30/955) patients, followed by the presence of hypertrophied conal artery seen in 2.62% (25/955) patients. The anomalous coronary artery was crossing the right ventricular outflow tract (RVOT) in all cases where the LAD artery was arising from RCA or right coronary sinus or where RCA was arising from the LAD artery. Coronary arterial anomalies were seen in a significantly higher proportion of patients with an atrial septal defect compared to those without (7/25 [28%] vs. 72/930 [7.74%]; p = .0003). Conclusion:The prevalence of anomalies of coronary arteries increases significantly in the presence of TOF as compared to the general population. Majority of these anomalous coronary arteries course anterior to the RVOT which can potentially pose technical difficulties with a risk of adverse surgical outcomes and increased morbidity and mortality, rendering their diagnosis crucial before surgery.

Intrapulmonary invagination of right subclavian artery with a dual left anterior descending artery in a child with tetralogy of Fallot

“…However, the concomitant occurrence of dual LAD with the high take‐off of RCA as observed in the present case is extremely rare. In presence of accessory LAD, the course of the artery in relation to the right ventricular outflow tract impacts the surgical strategy while high take‐off of RCA can pose problems at the time of aortic clamping 4 . It is imperative to depict such anomalies preoperatively as it influences the timing and the type of surgery being performed and avoids inadvertent coronary artery injury which can lead to significant morbidity and mortality.…”

“…In presence of accessory LAD, the course of the artery in relation to the right ventricular outflow tract impacts the surgical strategy while high take-off of RCA can pose problems at the time of aortic clamping. 4 It is imperative to depict such anomalies preoperatively as it influences the timing and the type of surgery being performed and avoids inadvertent coronary artery injury which can lead to significant morbidity and mortality. This case highlights the role of CTA in depicting vascular anatomy (arch vessels and coronary arteries) in patients with congenital heart diseases and in the planning of surgical management.…”