The surgical management of tetralogy of Fallot (TF) may be complicated by anomalies in the course and distribution of coronary arteries. Selective coronary angiography was performed in 119 cases of TF in order to prevent injury of aberrant vessels. In 11 patients, anomalies in the origin of coronary branches were revealed (five patients with a single coronary ostium, five with the anterior descending coronary artery arising from the right coronary artery or right sinus of Valsalva, and one with the circumflex artery arising from the right coronary artery). Other findings include anastomoses between coronary and bronchial arteries, small fistulas between coronary arteries and the pulmonary artery or right atrium, and hypoplasia of the coronary tree. The onset of left anterior hemiblock after total correction of TF could possibly be explained, in cases with a dominant left pattern, by injury to the coronary system after closure of the interventricular septal defect, rather than by injury to the conduction system.
Our results of stent-graft treatment of complicated and uncomplicated diseases of the descending aorta confirms that this alternative to open repair is a safe, less invasive, and relatively low risk approach. Medium-term follow-up results suggest that it is effective and durable therapy with low associated mortality and morbidity rates.
One hundred-five patients (median age 14 months) in whom a PTFE prosthesis was used to create a systemic-pulmonary artery shunt were studied between 1978 and 1980. The prosthesis was mainly used to create a modified Blalock-Taussig anastomosis. Nine patients died in hospital (8.5%, 70% confidence limits: 5.7% to 12.3%). The clinical condition did not appear to be an incremental risk factor, while the young age and the underlying type of disease accounted for the hospital mortality to a large extent. All 96 survivals were available for follow-up information. One graft, which was damaged intraoperatively, occluded 3 months later. The remaining patients have a patent graft 3 months to 36 months (mean 24 months) postoperatively. In 6 patients the patency was assessed angiographically and no damages of the pulmonary artery were observed, therefore this type of palliation is advisable for any patient, particularly in the first year of life.
Summary: Thirty-four patients with right bundle-branch block (RBBB) and coronary artery disease (CAD) (RBBB was not pre-existent to clinical development of CAD) and 52 consecutive CAD patients without conduction disturbances were studied and compared to verify whether the presence of RBBB implies more severe and extensive left ventricular myocardial damage as well as more severe CAD. The two groups did not differ either in age or in New York Heart Association functional class. The incidence or location of previous myocardial infarction (MI) was not different in the two groups. No significant differences were found in left ventricular volumes or ejection fraction. Higher end-diastolic left ventricular pressure and more severe and diffuse left ventricular wall asynergy were present in RBBB patients. At coronary axteriography, more severe involvement of the right coronary artery in CAD patients without conduction disturbances was the only significant finding. The group of patients with CAD and RBBB without MI showed significantly less involvement of the left anterior descending coronary artery and significantly more severe damage of the inferior wall of the left ventricle than the group with CAD without RBBB and MI. Patients with inferior wall MI and RBBB had more severe asynergy of the posterobasal region of the left ventricle than did patients with inferior wall MI without RBBB. The group of patients with anterior wall MI and RBBB had a higher left ventricular end-diastolic pressure, a lower left ventricular ejection fraction, and a greater extent of myocardial damage compared to similar patients of the control group. The groups with MI and RBBB had the same Gensini's score as similar groups without RBBB. The hemodynamic, angiographic, and ventriculographic findings in 14 of the 34 RBBB patients who had also presented an abnormal QRS frontal axis deviation showed no significant differences in comparison both with the CAD control group and the remaining RBBB patients with normal QRS frontal axis. These data support the hypothesis that conduction defects and diffuse left ventricular damage do not emanate from anatomical coronary lesions.
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