scholarly journals What is the best angiographic view for detection of coronary artery abnormality in Tetralogy of Fallot? A retrospective study

2019 ◽  
Author(s):  
Mohammad reza Edraki ◽  
Reza Dehdab ◽  
Nima Mehdizadegan ◽  
Hamid Mohammadi ◽  
Hamid Amoozgar ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Coronary Artery ◽  
Tetralogy Of Fallot ◽  
Sensitivity And Specificity ◽  
Open Heart Surgery ◽  
Right Ventricular Outflow Tract ◽  
Coronary Anatomy ◽  
Coronary Artery Anatomy ◽  
The Right ◽  
Left Anterior Oblique

Abstract Background The definite treatment of tetralogy of Fallot (TOF) as the most common cyanotic congenital heart disease is open heart surgery and the operation technique depends on the coronary artery anatomy. We aimed to evaluate the sensitivity and specificity of various root Aortogram views to detect abnormal coronary artery configuration and course in these patients.Methods In this retrospective study, the reports of coronary anatomy in angiography and operation notes of TOF patients since 2005 to 2017 were evaluated. The sensitivity and specificity of the two common root Aortogram views including the left anterior oblique/cranial (LAO/CRA) and left anterior oblique/caudal (LAO/CAU) were determined.Results 451 patients with the median age of 28 months (3-432 months) were included. All patients had LAO/CRA views and 199 patients had both LAO/CRA and LAO/CAU views. The rate of coronary abnormalities reported by surgery was 8%, and abnormal origin of the left anterior descending artery from the right coronary artery was the most common reported anomaly (4.4%). The sensitivity of the LAO/CAU view was 100%, but LAO/CRA view was about 75% in detecting abnormal coronary configuration. Both of them had excellent specificity (~100%). No significant sex difference was seen between different coronary anatomy abnormalities.Conclusion The Caudal root angiogram is an essential view to evaluate coronary artery anatomy in TOF patients and it seems that there is no need for other views like lateral view, but relying on LAO/CRA view alone may lead to significant misdiagnosis of the coronary arteries, crossing the right ventricular outflow tract (RVOT).

scholarly journals Detection of Coronary Artery Anomaly in Tetralogy of Fallot: Comparison of Two Angiographic Views

2020 ◽  
Vol 30 (5) ◽  
Author(s):  
Mohammad Reza Edraki ◽  
Reza Dehdab ◽  
Nima Mehdizadegan ◽  
Hamid Mohammadi ◽  
Hamid Amoozgar ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Tetralogy Of Fallot ◽  
Sensitivity And Specificity ◽  
Open Heart Surgery ◽  
Right Ventricular Outflow Tract ◽  
Coronary Anatomy ◽  
Coronary Artery Anatomy ◽  
Coronary Abnormalities ◽  
The Right ◽  
Left Anterior Oblique

Background: The definite treatment of tetralogy of Fallot (TOF) as the most common cyanotic congenital heart disease is open heart surgery and the operation technique depends on the coronary artery anatomy. Objectives: We aimed to evaluate the sensitivity and specificity of various root Aortogram views to detect abnormal coronary artery configuration and course in these patients. Methods: In this retrospective study, the reports of coronary anatomy in angiography and operation notes of TOF patients since 2005 to 2018 were evaluated. The sensitivity and specificity of the two common root Aortogram views including the left anterior oblique/cranial (LAO/CRA) and left anterior oblique/caudal (LAO/CAU) were determined. Results: Four hundred and fifty one patients with the median age of 28 months (3 - 432 months) were included. All patients had LAO/CRA views and 199 patients had both LAO/CRA and LAO/CAU views. The rate of coronary abnormalities reported by surgery was 8%, and abnormal origin of the left anterior descending artery from the right coronary artery was the most common reported anomaly (4.4%). The sensitivity of the LAO/CAU view was 100%, but LAO/CRA view was about 75% in detecting abnormal coronary configuration. Both of them had excellent specificity (~100%). No significant sex difference was seen between different coronary anatomy abnormalities. Conclusions: The Caudal root angiogram is an essential view to evaluate coronary artery anatomy in TOF patients and it seems that there is no need for other views like lateral view, but relying on LAO/CRA view alone may lead to significant misdiagnosis of the coronary arteries, crossing the right ventricular outflow tract (RVOT).

Correction of Tetralogy of Fallot Associated With Anomalous Coronary Artery Without Extracardiac Conduit

2020 ◽  
Vol 11 (3) ◽  
pp. 343-345 ◽  
Author(s):  
Kaoutar Benjaout ◽  
Julia Mitchell ◽  
Julie Gauthier ◽  
Jean Ninet
Keyword(s):  
Coronary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Anomalous Coronary Artery ◽  
Extracardiac Conduit ◽  
The Right ◽  
Anomalous Coronary

Between 1983 and 2016, we operated on 14 children with tetralogy of Fallot with an anomalous coronary artery crossing the pulmonary infundibulum, which is an anomaly that makes the repair complex. The technique used was the enlargement of the right ventricular outflow tract underneath the mobilized coronary artery. All patients had right ventricular outflow tract relief without coronary artery injury. Only one patient required the use of an extracardiac conduit. There was neither in-hospital mortality nor coronary anomaly requiring reintervention. Mobilizing the anomalous coronary artery in tetralogy of Fallot repair often allows relief of obstruction without using an extracardiac conduit.

Tetralogy of fallot with anomalous origin of the right coronary artery

1995 ◽  
Vol 59 (1) ◽  
pp. 229-231 ◽  
Author(s):  
R. Lawrence Moss ◽  
Carl L. Backer ◽  
Vincent R. Zales ◽  
Michael S. Florentine ◽  
Constantine Mavroudis
Keyword(s):  
Coronary Artery ◽  
Tetralogy Of Fallot ◽  
Right Coronary Artery ◽  
Anomalous Origin ◽  
The Right

Giant pseudo-aneurysm of the right ventricular outflow tract after Tetralogy of Fallot repair

2019 ◽  
Vol 30 (9) ◽  
pp. 1332-1334
Author(s):  
João Rato ◽  
Rita Ataíde ◽  
Ana Teixeira
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Surgical Correction ◽  
Pseudo Aneurysm ◽  
The Right ◽  
Tetralogy Of Fallot Repair

AbstractImages of the diagnosis and correction of a pseudo-aneurysm at the right ventricular outflow tract, one of the rarest complications of Tetralogy of Fallot surgical correction.

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

2019 ◽  
Vol 56 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Margaux Pontailler ◽  
Chloé Bernard ◽  
Régis Gaudin ◽  
Anne Moreau de Bellaing ◽  
Mansour Mostefa Kara ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mortality Rate ◽  
Tetralogy Of Fallot ◽  
Pressure Ratio ◽  
Pulmonary Stenosis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Early Mortality ◽  
Abnormal Coronary Artery

AbstractOBJECTIVESRepair 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.METHODSWe 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).RESULTSThe 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.CONCLUSIONSRepair 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.

Progressive right ventricular outflow tract fibrosis after repair of tetralogy of Fallot

2020 ◽  
Vol 30 (9) ◽  
pp. 1366-1367
Author(s):  
Gauri R. Karur ◽  
Wadi Mawad ◽  
Lars Grosse-Wortmann
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
T1 Mapping ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
The Right

AbstractObjectives:The objective of this study was to determine the evolution of fibrosis over time and its association with clinical status.Methods:Children with repaired tetralogy of Fallot who had undergone at least two cardiac magnetic resonance examinations including T1 mapping at least 1 year apart were included.Results:Thirty-seven patients (12.7 ± 2.6 years, 61% male) were included. Right ventricular free wall T1 increased (913 ± 208 versus 1023 ± 220 ms; p = 0.02). Baseline cardiac magnetic resonance parameters did not predict a change in imaging markers or exercise tolerance. The right ventricular free wall per cent change correlated with left ventricular T1% change (r = 0.51, p = 0.001) and right ventricular mass Z-score change (r = 0.51, p = 0.001). T1 in patients with late gadolinium enhancement did not differ from the rest.Conclusion:Increasing right ventricular free wall T1 indicates possible progressive fibrotic remodelling in the right ventricular outflow tract in this pilot study in children and adolescents with repaired tetralogy of Fallot. The value of T1 mapping both at baseline and during serial assessments will need to be investigated in larger cohorts with longer follow-up.

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