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Coronary artery anomalies in tetralogy of Fallot
S Shrivastava1, J C Mohan, S Mukhopadhyay
1Department of Cardiology, All-India Institute of Medical Sciences, New Delhi.
Insights
Coronary anomalies are present in 11.8% of Fallot
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Fallot's tetralogy is a complex congenital heart defect.
- Coronary artery anomalies can impact surgical outcomes in these patients.
Purpose of the Study:
- To investigate the prevalence and types of coronary artery anomalies in patients with Fallot's tetralogy.
- To assess the diagnostic utility of aortic root angiography for visualizing these anomalies.
Main Methods:
- Retrospective review of coronary angiograms from 296 patients with Fallot's tetralogy.
- Classification of coronary anomalies into congenital (Group I) and acquired (Group II).
- Analysis of diagnostic yield of aortic root angiography versus selective coronary angiography.
Main Results:
- Congenital coronary anomalies were identified in 11.8% (32/296) of patients.
- Common anomalies included single coronary artery, left anterior descending artery originating from the right coronary artery, and accessory left anterior descending artery.
- Acquired abnormalities were found in 11 cases, primarily enlarged conus artery.
Conclusions:
- Coronary artery anomalies are relatively common in Fallot's tetralogy.
- Aortic root angiography is generally sufficient for delineating coronary anatomy.
- Identifying these anomalies is crucial for surgical planning and improving patient outcomes, particularly in infants.
Abstract:
Coronary angiograms of 296 patients with Fallot's tetralogy were reviewed. Group I abnormalities in the origin and distribution of the coronary arteries, found in 32 (11.8%) cases, consisted of a single coronary artery from the left sinus of Valsalva in 7 cases, left anterior descending artery from the right coronary artery in 7 cases, and an accessory left anterior descending from the right coronary in 18 cases. Of the 7 cases with a single coronary artery, the right coronary branch was anterior to the aortic root, crossing the right ventricular outflow in two cases. Group II acquired abnormalities were found in 11 cases and consisted of an enlarged conus artery in 9 cases and 1 case each of coronary bronchial collateral and right ventricular branch from the left anterior descending artery. Except in 12 patients requiring selective coronary angiography, aortic root angiography was sufficient to outline the coronary anatomy. Awareness of a coronary anomaly helps in deciding the time and type of operative procedure to be performed, especially in infants, since injury to a large vessel perfusing the left ventricle usually results in increased morbidity and mortality.