scholarly journals A single coronary artery with left circumflex artery crossing right ventricular outflow tract in tetralogy of Fallot with absent left pulmonary artery

2020 ◽  
Vol 13 (1) ◽  
pp. 87-89
Author(s):  
Vivek Jaswal ◽  
Shyam Kumar Singh Thingnam ◽  
Vikas Kumar ◽  
Ruchit Patel ◽  
Ganesh Kumar Munirathinam ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Single Coronary Artery ◽  
Circumflex Artery ◽  
Left Circumflex Artery

Tetralogy of Fallot (TOF) with unilateral absence of pulmonary artery and the anomalous coronary artery is a rare combination. Detailed preoperative evaluation of coronary artery anatomy is must to prevent injury to the major vessels crossing right ventricular outflow tract. We report a rare association of single coronary artery with left circumflex artery crossing right ventricular outflow tract close to the pulmonary annulus in tetralogy of Fallot with absent left pulmonary artery in 11-year-old girl. Though there is a great diversity of coronary anomalies in tetralogy of Fallot, the prepulmonic course of left circumflex artery crossing the right ventricular outflow tract (RVOT) close to the pulmonary annulus has rarely been described in the literature. The patient underwent successful primary single lung intracardiac repair. Right ventricular outflow tract obstruction was treated by handmade valved pericardial autologous conduit and release of the tethering of hypoplastic native unicuspid pulmonary valve leaflet maintaining its integrity.

Tetralogy of Fallot: stent palliation or neonatal repair?

2021 ◽  
pp. 1-9
Author(s):  
Adeolu Banjoko ◽  
Golnoush Seyedzenouzi ◽  
James Ashton ◽  
Fatemeh Hedayat ◽  
Natalia N. Smith ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Hospital Length Of Stay ◽  
Mortality And Morbidity

Abstract Surgical repair of Tetralogy of Fallot has excellent outcomes, with over 90% of patients alive at 30 years. The ideal time for surgical repair is between 3 and 11 months of age. However, the symptomatic neonate with Tetralogy of Fallot may require earlier intervention: either a palliative intervention (right ventricular outflow tract stent, ductal stent, balloon pulmonary valvuloplasty, or Blalock-Taussig shunt) followed by a surgical repair later on, or a complete surgical repair in the neonatal period. Indications for palliation include prematurity, complex anatomy, small pulmonary artery size, and comorbidities. Given that outcomes after right ventricular outflow tract stent palliation are particularly promising – there is low mortality and morbidity, and consistently increased oxygen saturations and increased pulmonary artery z-scores – it is now considered the first-line palliative option. Disadvantages of right ventricular outflow tract stenting include increased cardiopulmonary bypass time at later repair and the stent preventing pulmonary valve preservation. However, neonatal surgical repair is associated with increased short-term complications and hospital length of stay compared to staged repair. Both staged repair and primary repair appear to have similar long-term mortality and morbidity, but more evidence is needed assessing long-term outcomes for right ventricular outflow tract stent palliation patients.

Stenting of the right ventricular outflow tract in symptomatic neonatal tetralogy of Fallot

2013 ◽  
Vol 24 (2) ◽  
pp. 369-373 ◽  
Author(s):  
Nikolaus A. Haas ◽  
Thorsten K. Laser ◽  
Axel Moysich ◽  
Ute Blanz ◽  
Eugen Sandica
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Regurgitation ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ventricular Performance ◽  
Right Ventricular Performance ◽  
The Right

AbstractThere is ongoing debate regarding the initial management of symptomatic neonates with tetralogy of Fallot. Although neonatal repair can be performed with low mortality, it is associated with increased morbidity and long-term impact on right ventricular performance. Traditionally, the modified Blalock–Taussig shunt remains the palliative procedure of choice. Differential pulmonary artery flow may occur and subsequently result in underdevelopment and distortion of pulmonary vessels. Transcatheter therapy was previously limited to balloon valvulotomy when the obstruction is predominantly at the pulmonary valve level. Stenting of the right ventricular outflow tract can enable adequate forward flow; however, pulmonary regurgitation may impact on right ventricular performance and cardiac output. Stenting of the right ventricular outflow tract with valve sparing placement of the stent thus treating the underlying pathophysiology of the hypercyanotic spells provides a safe and effective management strategy, improving arterial oxygen saturation, avoiding pulmonary regurgitation and encouraging pulmonary artery growth.

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.

Coronary artery diseases after right ventricular outflow tract reconstruction surgery

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Kwon ◽  
E.J Bae ◽  
G.B Kim ◽  
S.Y Lee ◽  
M.K Song ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Interquartile Range ◽  
Single Coronary Artery ◽  
Congenital Aortic Stenosis ◽  
Reconstruction Surgery ◽  
Tertiary Center

Abstract Background The occurrence of coronary artery disease (CAD) is unknown to date in patients who have undergone the right ventricular outflow tract (RVOT) reconstruction surgery for congenital heart disease using a bioprosthetic valve or conduit. Purpose We present the incidence and outcomes of CAD in patients who underwent RVOT reconstruction surgery in a single tertiary center. Method From April 1986 to February 2019, 544 patients underwent Rastelli operation or pulmonary valve replacement for conotruncal anomalies at the Seoul National University Children's Hospital in Korea. The patient's medical records and imaging findings were analyzed retrospectively. Results Significant coronary stenosis or occlusion were observed in 19 patients (3.5%) after RVOT reconstruction surgery. Their underlying diseases were pulmonary atresia in 8, tetralogy of Fallot in 3, double outlet right ventricle with pulmonary stenosis in 3, truncus arteriosus in 2, congenitally corrective transposition of great artery in 2, and congenital aortic stenosis in 1. Mechanism of CAD was compression of coronary artery by artificial conduit or valve in 10, intraoperative coronary injury in 7, and intramural course of coronary artery in 2 patients. The median number of RVOT reconstruction surgery before the diagnosis of CAD was 2 times (interquartile range: 2–3 times). The median age at diagnosis of CAD was 15 years (interquartile range: 9.5 - 25 years). The median time to detection of the CAD from the last RVOT reconstruction surgery was 9 years (interquartile range: 3.5–12.5 years). Involved coronary artery was right coronary artery (RCA) in 10, left anterior descending coronary artery (LAD) in 7, and left main coronary artery in 2 patients. Seven (36.8%) patients had underlying congenital coronary anomalies, such as single coronary artery, intramural course of the coronary artery, and anomalous origin of the coronary artery from an abnormal sinus. One patient died due to brain injury on extracorporeal membrane oxygenator after intraoperative coronary injury. Two patients with intramural course of coronary artery and one patient with high take-off of RCA which was compressed by adjacent calcified conduit underwent surgical repair of the CAD. One patient with recurrent ventricular tachycardia needed an implantable cardioverter-defibrillator. Nine patients are on medication for heart failure. Three patients with total occlusion of RCA or LAD showed well-developed collaterals from another normal coronary artery. Conclusion CAD after RVOT reconstruction surgery are not common but can be fatal. Because the clinical significance of CAD and long-term prognosis are not known yet, we need to closely track the patient after RVOT reconstruction surgery. Indications for the management of the CAD should be prepared to prevent sudden cardiac death, arrhythmia, and ventricular dysfunction in these patients. Funding Acknowledgement Type of funding source: None

Stenting of the right ventricular outflow tract as an initial intervention in Tetralogy of Fallot with pulmonary stenosis and major aortopulmonary collateral arteries

2020 ◽  
pp. 1-8
Author(s):  
Mohammad Abumehdi ◽  
Deepa Sasikumar ◽  
Milind Chaudhari ◽  
Vinay Bhole ◽  
Phil Botha ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Stenosis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Major Aortopulmonary Collateral Arteries ◽  
Collateral Arteries ◽  
Aortopulmonary Collateral

Abstract Objectives: To assess the role of right ventricular outflow tract stenting as the primary intervention in Tetralogy of Fallot with pulmonary stenosis and major aortopulmonary collateral arteries. Background: The management of a subset of infants with Tetralogy of Fallot with pulmonary stenosis and major aortopulmonary collateral arteries requires a staged approach including rehabilitation of diminutive native pulmonary arteries, conventionally using an aortopulmonary shunt. We share our experience of pulmonary artery rehabilitation with right ventricular outflow tract stenting. Methods: Retrospective review of all patients with Tetralogy of Fallot with pulmonary stenosis who underwent right ventricular outflow tract stenting as primary intervention over an 8-year period. Results: Ten patients underwent right ventricular outflow tract stent insertion at a median age of 61 days (interquartile range (IQR) 8.3–155 days). Median weight at stent deployment was 4.2 kg (IQR 3.2–5.7 kg). Oxygen saturations improved from a median of 79% (IQR 76–80%) to 92% (IQR 90–95%), p = 0.012. The median right and left pulmonary artery z score increased from −3.51 (IQR −4.59 to −2.80) and −2.07 (IQR −3.72 to 0.15) to a median of −1.17 (IQR −2.26 to 0.16) p < 0.05, and 0.24 (IQR −1.09 to 1.84) p < 0.05, respectively, at subsequent angiogram. Nine patients underwent further catheterisation. Four patients underwent complete anatomical repair. Only one patient required unifocalisation, as most patients had a native supply to all-important lung segments. Conclusion: Right ventricular outflow tract stenting is a useful procedure in the subset of patients with Tetralogy of Fallot with pulmonary stenosis and major aortopulmonary collateral arteries, where native pulmonary arterial growth is required to facilitate repair.

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