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Coronary arterial anatomy in tetralogy of Fallot: morphological and clinical correlations
J Li1, N D Soukias, J S Carvalho
1Imperial College School of Medicine, National Heart and Lung Institute, London, UK.
Insights
Diagnosing coronary arteries crossing the right ventricular outflow tract in tetralogy of Fallot requires specific imaging views. Combining "laid back" and straight lateral views prevents misidentifying normal branches as aberrant coronary arteries.
Area of Science:
- Cardiovascular imaging
- Congenital heart disease
- Anatomical variations
Background:
- Accurate diagnosis of coronary artery anomalies is crucial in congenital heart disease.
- Tetralogy of Fallot presents unique challenges in visualizing coronary arteries due to anatomical variations.
Purpose of the Study:
- To identify and address diagnostic challenges in angiographic assessment of coronary arteries related to the right ventricular outflow tract.
- To improve the accuracy of diagnosing aberrant coronary arteries in patients with tetralogy of Fallot.
Main Methods:
- Retrospective analysis of clinicomorphological data.
- Review of aortograms and surgical reports from 130 tetralogy of Fallot cases and 36 necropsy specimens.
- Correlation of imaging findings with surgical outcomes.
Main Results:
- Preventricular branches were identified in 19% of tetralogy of Fallot cases, absent in normal hearts.
- Aberrant anterior interventricular coronary artery origin occurred in 14% of specimens.
- Combined "laid back" and straight lateral views improved detection of anomalies, with surgical confirmation in 7/9 identified cases.
Conclusions:
- The "laid back" view alone can lead to false positives, mistaking infundibular or preventricular branches for aberrant arteries.
- A combination of "laid back" and straight lateral views is essential for accurate diagnosis.
- This approach minimizes misdiagnosis of coronary artery anomalies in the context of tetralogy of Fallot.
Objective:
To clarify the problems in angiographic diagnosis of major coronary arteries crossing the right ventricular outflow tract.
Design:
A retrospective study with clinicomorphological correlations to ascertain any aberrant coronary arteries and variations in distribution of the normal right coronary arterial branches.
Setting:
Tertiary referral centre.
Subjects:
36 necropsy specimens together with the aortograms and surgical reports from 130 patients with tetralogy of Fallot.
Results:
A preventricular branch was found in 19% of cases with tetralogy of Fallot, but in none of 13 normal hearts. Aberrant origin of the anterior interventricular coronary artery was found in 14% of the specimens. The combination of "laid back" and straight lateral views, when reviewed retrospectively, identified this anomaly correctly in nine of 16 patients, with these findings confirmed at surgery in seven patients. A major branch initially thought to cross the outflow tract was shown retrospectively to be an infundibular artery in six, with surgical confirmation in four. It was a preventricular branch in another patient.
Conclusions:
Using the laid back view alone, infundibular and preventricular branches may be mistaken for a major aberrant artery. A combination of laid back and straight lateral views is needed to avoid false positive diagnosis.