Anomalies of coronary arteries in tetralogy of Fallot: Evaluation on multidetector CT angiography using dual-source
Niraj Nirmal Pandey1, Kanika Bhambri1, Mansi Verma1
1Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
Insights
Coronary artery anomalies are more common in tetralogy of Fallot (TOF) patients, with many crossing the right ventricular outflow tract. Early diagnosis is crucial for surgical success and improved patient outcomes.
Area of Science:
- Cardiovascular Imaging
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Tetralogy of Fallot (TOF) is a complex congenital heart defect.
- Understanding coronary artery variations in TOF is critical for surgical planning.
Purpose of the Study:
- To determine the prevalence of coronary artery anomalies in pediatric patients with TOF.
- To evaluate the patterns and anatomical course of these anomalies using multidetector CT angiography.
Main Methods:
- Retrospective analysis of 955 pediatric patients with TOF.
- Review of dual-source CT angiographies for coronary artery origin, course, and termination.
- Assessment of associated cardiovascular anomalies.
Main Results:
- Coronary artery anomalies were found in 8.27% of TOF patients.
- The most common anomaly was the left anterior descending artery originating from the right coronary artery or sinus (3.14%).
- Anomalous arteries frequently crossed the right ventricular outflow tract (RVOT), particularly when associated with atrial septal defects.
Conclusions:
- TOF patients exhibit a significantly higher prevalence of coronary artery anomalies than the general population.
- Anomalous coronary arteries anterior to the RVOT pose surgical challenges, increasing risks.
- Preoperative diagnosis of these anomalies is essential to mitigate surgical complications and improve outcomes.
Objectives:
The present study sought to determine the prevalence and evaluate the patterns of various anomalies of coronary arteries in patients with tetralogy of Fallot (TOF) on multidetector CT angiography using a dual-source CT scanner.
Methods:
We retrospectively reviewed CT angiographies of 955 pediatric patients, diagnosed with TOF between 1st January 2015 and 31st December 2019 and having an optimal evaluation of coronary arteries, with respect to the origin, course, and termination of the coronary arteries and associated cardiovascular anomalies.
Results:
Anomalies of coronary arteries were observed in 8.27% (79/955) patients with TOF. Origin of accessory/proper left anterior descending (LAD) artery from right coronary artery (RCA) or right coronary sinus was the most common anomalous pattern, seen in 3.14% (30/955) patients, followed by the presence of hypertrophied conal artery seen in 2.62% (25/955) patients. The anomalous coronary artery was crossing the right ventricular outflow tract (RVOT) in all cases where the LAD artery was arising from RCA or right coronary sinus or where RCA was arising from the LAD artery. Coronary arterial anomalies were seen in a significantly higher proportion of patients with an atrial septal defect compared to those without (7/25 [28%] vs. 72/930 [7.74%]; p = .0003).
Conclusion:
The prevalence of anomalies of coronary arteries increases significantly in the presence of TOF as compared to the general population. Majority of these anomalous coronary arteries course anterior to the RVOT which can potentially pose technical difficulties with a risk of adverse surgical outcomes and increased morbidity and mortality, rendering their diagnosis crucial before surgery.
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