Coronary artery anomalies in patients with tetralogy of Fallot

Meyer, Joseph; Chiariello, Luigi; Hallman, Grady L.; Cooley, Denton A.

doi:10.1016/s0022-5223(19)41556-0

Cited by 35 publications

(12 citation statements)

References 3 publications

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“…However, a major coronary branch crossing the right ventricular outflow tract can easily change the surgical strategy. An injury to this coronary branch can lead to severe and sometimes fatal complications 1‐3 . Even these coronary artery anomalies might be encountered in a large number of cyanotic congenital cardiac pathologies; TOF patients constituting one of the major groups 8 .…”

Section: Discussionmentioning

confidence: 99%

“…The symptomatology of the patients with abnormal coronary artery does not differ from those of other TOF patients. The electrocardiographic and chest X‐ray examinations have no importance in the differential diagnosis of the coronary artery abnormalities 3 . Although experienced cardiologists can successfully detect major coronary artery abnormalities by echocardiographic study, the definitive diagnosis must be carried out with selective coronary arteriography (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Abnormality in the distribution of the coronary arteries is a major challenge complicating the repair of tetralogy of Fallot (TOF). About 2% to 10% of patients with TOF have an anomalous coronary artery crossing the right ventricular outflow tract (RVOT) 1‐6 . This abnormal course of the coronary arteries poses special problems, leading the surgeon to change the classical way of TOF repair.…”

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confidence: 99%

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Right Ventricular Outflow Tract Reconstruction for Tetralogy of Fallot with Abnormal Coronary Artery: Experience with 35 Patients

et al. 2006

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Right Ventricular Outflow Tract Reconstruction for Tetralogy of Fallot with Abnormal Coronary Artery: Experience with 35 Patients

et al. 2006

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“…Some authors of case reports or of studies with larger cohorts have also reported their experience with the surgical management of ToF and associated ACA [1,8,15,17]. Although the early mortality rate was reported to be 8-15% before the 1990s, it has clearly dropped below 10% during the last 20 years and now ranges between 0% and 6% [1,8,[10][11][12][13][14]17].…”

Section: Mortality and Coronary Artery Damagementioning

confidence: 99%

“…Because this anomalous CA (ACA) most frequently crosses the infundibular region, it can lead to technical difficulties during the surgical repair and to increased morbidity and mortality rates. A CA lesion can occur if this abnormal course was undiagnosed before or during surgery, leading to severe myocardial ischaemia and inadequate or imperfect surgical correction of the right ventricular outflow tract (RVOT) obstruction [8].…”

Section: Introductionmentioning

confidence: 99%

Tetralogy of Fallot and abnormal coronary artery: use of a prosthetic conduit is outdated

Pontailler

Bernard

Gaudin

et al. 2019

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Repair of tetralogy of Fallot (ToF) can be challenging in the presence of an abnormal coronary artery (CA) in 5–12% of cases. The aim of this study was to report our experience with ToF repair without the systematic use of a right ventricle-to-pulmonary artery (RV-PA) conduit. METHODS We conducted a monocentric retrospective study from 2000 to 2016, including 943 patients with ToF who underwent biventricular repair, of whom 8% (n = 76) presented with an abnormal CA. Mean follow-up time was 50 months (1 month–18 years). RESULTS The most frequent CA anomaly was the left descending artery arising from the right CA (n = 47, 61.8%). The median age at repair was 7.7 months (1.8 months–16 years). Thirteen patients (17%) required prior palliation, mostly systemic pulmonary shunts for anoxic spells in the neonatal period. Surgical repair allowed us to preserve the annulus in 40 patients (53%) by combining PA trunk plasty, commissurotomy and infundibulotomy under the abnormal CA. If the annulus had to be opened (n = 35, 46%), a transannular patch was inserted after a vertical incision of the PA trunk and extended obliquely on the RV over the anomalous crossing CA (with an infundibulotomy under the abnormal CA). Three patients (4%) required the insertion of an RV-PA conduit (1 valved tube and 2 RV-PA GORE-TEX tubes with annulus conservation). The early mortality rate was 4% (n = 3); none of the deaths was coronary related. Four patients (5%) required reoperation (2 early and 2 late reoperations) for residual pulmonary stenosis, 3 of whom had annulus preservation during the initial repair. The mean RV/left ventricle (LV) pressure ratio and an RV/LV pressure ratio >2/3 were identified as risk factors for right ventricular outflow tract (RVOT) reinterventions (P = 0.0026, P = 0.0085, respectively), RVOT reoperations (P = 0.0002 for both) and reoperation for RVOT residual stenosis (P = 0.0002, P = 0.0014, respectively). Two patients underwent pulmonary valve replacement. Freedom from late reoperation was 100% at 1 year, 97% at 5 years and 84% at 10 and 15 years. CONCLUSIONS Repair of ToF and abnormal CA can be performed without an RV-PA conduit, with an acceptable low reintervention rate. The high early mortality rate in this series remains a concern. If any doubt remains about the surgical relief of the RVOT obstruction, the RV/LV pressure ratio should always be measured in the operating room.

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