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Coronary arterial dominance in patients with congenital heart disease

Masaru Kobayashi1, Jun Muneuchi2, Yuichiro Sugitani1

  • 1Department of Pediatrics, Kyushu Hospital Japan Community Healthcare Organization, 1-8-2, Kishionura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8507, Japan.

Heart and Vessels
|March 31, 2022
PubMed

Insights

Right coronary arterial dominance is common in congenital heart disease patients, especially those with tetralogy of Fallot (TOF). This finding suggests TOF patients may face higher risks for adult coronary artery disease.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Right coronary arterial dominance is a risk factor for three-vessel coronary artery disease.
  • Understanding coronary dominance in congenital heart disease (CHD) is crucial for managing ischemic heart disease.
  • Tetralogy of Fallot (TOF), ventricular septal defect (VSD), and Kawasaki disease (KD) are common CHDs with potential cardiac implications.

Purpose of the Study:

  • To investigate the prevalence and predictors of coronary arterial dominance in pediatric patients with CHD.
  • To determine if specific CHD types are associated with an increased likelihood of right coronary arterial dominance.

Main Methods:

  • Retrospective analysis of ascending aortography in 250 pediatric patients (105 TOF, 100 VSD, 45 KD).
  • Assessment of coronary arterial dominance, coronary artery Z-scores, and ascending aortic curvature.
  • Statistical analysis to identify factors associated with right coronary arterial dominance.

Main Results:

  • Right coronary arterial dominance was significantly higher in patients with TOF (89%), VSD (49%), and KD (61%) compared to general populations (P < 0.001).
  • TOF was the strongest predictor of right coronary arterial dominance (OR: 10.31, P < 0.001).
  • Significant differences in Z-scores for right coronary and anterior descending arteries were observed among TOF, VSD, and KD groups.

Conclusions:

  • A strong association exists between tetralogy of Fallot and right coronary arterial dominance.
  • Pediatric patients with TOF may have an elevated risk for developing coronary artery disease later in life.
  • Further research is warranted to explore long-term cardiovascular outcomes in CHD patients with varying coronary dominance patterns.

Keywords:
Coronary anomaliesCoronary artery diseaseKawasaki diseaseTetralogy of FallotVentricular septal defect

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