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).

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).

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.

Congenital Anomalies of the Coronary Arteries

2009 ◽  
Vol 5 (1) ◽  
pp. 12
Author(s):  
Peiman Jamshidi ◽  
Paul Erne ◽  
◽  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Congenital Anomalies ◽  
Left Coronary Artery ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Aortic Sinus ◽  
Coronary Abnormalities ◽  
The Right ◽  
Subsequent Passage

Multiple variations of congenital anomalies of the coronary arteries exist that may occur in isolation or in association with other congenital anomalies. They can cause myocardial ischaemia. A rare but potentially lethal condition is the anomalous origin of the left coronary artery from the pulmonary artery. The most common haemodynamically significant coronary abnormalities are coronary artery fistulae. A left-toright shunt exists in more than 90% of cases. The origin of the left coronary artery from the proximal right coronary artery (RCA) or the right aortic sinus with subsequent passage between the aorta and the right ventricular outflow tract has been associated with sudden death during or shortly after exercise in young persons. High anterior origin of the RCA is commonly encountered but is of no haemodynamic significance. It is difficult to engage the ostium of the RCA selectively using conventional catheter manipulation. In this article we will discuss various types of congenital coronary anomaly, providing examples.

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.

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