Detection of pulmonary and coronary artery anomalies in tetralogy of Fallot using non-ECG-gated CT angiography

Hruşcã, Adrian; Gach, P.; Pico, H.; Sorensen, C.; Bonello, Béatrice; Ovaert, Caroline; Petit, Philippe; Fouilloux, Virginie; Macé, Loı̈c; Gorincour, Guillaume

doi:10.1016/j.diii.2016.03.010

Cited by 22 publications

(27 citation statements)

References 32 publications

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“…Jureidini et al [20] accordingly report for two adolescents that the transthoracic echocardiography images were inadequate to visualize the coronary artery anatomy. Concordance rate between coronary angiography and surgery was 50-100% [9,22,31,33] and between CT-scan and surgery 92.1-100% [17,23,24]. Six studies found additional anomalies during surgery or defined the anatomy differently than described before based on coronary angiography or CT-scan [4,5,17,26,31,33].…”

Section: Discussion and Clinical Implicationsmentioning

confidence: 94%

“…These are the anomalies with the potentially largest clinical impact if not adequately identified and were grouped for analyses as 'ACA'. During review of the ACA, it was noticed that larger than normal conus arteries and coronary arteriovenous fistulas (CAVF) were also systematically described in several studies [5,10,[13][14][15][16][17][18][19][20][21][22][23][24][25]. The conus artery (also called infundibular artery) is the first anteriorly departing branch of the RCA; it may also originate from a separate ostium in the right sinus of Valsalva (Supplemental Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Hereof, 20 studies were included for the analysis of ACA crossing the RVOT. Six studies [14,18,23,[26][27][28] were excluded because they did not report the number of arteries crossing the RVOT. The other two studies [29,30] were excluded because of very small numbers (n = 2 and n = 1 resp.)…”

Section: Methodsmentioning

confidence: 99%

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Coronary anomalies in tetralogy of Fallot – A meta-analysis

Koppel

Jongbloed

Kiès

et al. 2020

International Journal of Cardiology

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Background: An anomalous coronary artery is reported in 2% to 23% of patients with tetralogy of Fallot (TOF). Knowledge of coronary anatomy prior to corrective surgery is vital to avoid damage to vessels crossing the right ventricular outflow tract (RVOT). A meta-analysis on the prevalence of anomalous coronary arteries in TOF is lacking to date. Here, an overview of coronary anomalies in TOF is provided and implications for patient management are discussed. Methods: PubMed, Embase and Web of Science were searched. Analysis was done using Revman 5.3 (Cochrane Community, London). The primary analysis focused on the origin and proximal course of the right and left coronary arteries. In addition, the prevalence of large conus arteries and coronary arteriovenous fistulas (CAVF) was calculated. Results: Twenty-eight studies, encompassing 6956 patients, were included; 6% of TOF patients have an anomalous coronary artery. Hereof, 72% cross the RVOT; the majority of the remaining 28% courses behind the aorta. Six percent of patients have a large conus artery and 4% a CAVF. Other coronary anomalies include a left or right coronary artery from the pulmonary trunk or left or right pulmonary artery, coronary tree hypoplasia and anastomoses between coronary and bronchial arteries. Conclusions: The prevalence of coronary anomalies in TOF is 4-6%. In patients with an anomalous coronary artery, 72% cross the RVOT. The combined risk of encountering an anomalous coronary artery or a large conus artery crossing the RVOT is 10.3%. Coronary anatomy should be defined before surgery and the surgical approach adapted accordingly.

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Section: Discussion and Clinical Implicationsmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

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Coronary anomalies in tetralogy of Fallot – A meta-analysis

Koppel

Jongbloed

Kiès

et al. 2020

International Journal of Cardiology

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“…The preoperative diagnosis of ACA is usually made with echocardiography if it is performed by senior cardiologists. Computed tomography is a non-invasive imaging technique with high sensitivity and specificity for CA anatomical analysis, but cardiac catheterization remains the gold standard for accurate coronary diagnosis, although it is not mandatory before surgery [4,5,7,20]. We do not recommend mandatory computed tomography imaging when ACA is suspected (because it would not change the indication for surgery) except for patients who had a palliative operation elsewhere without a specific description of the coronary anatomy at first surgery.…”

Section: Tetralogy Of Fallot and Abnormal Coronary Arterymentioning

confidence: 99%

Tetralogy of Fallot and abnormal coronary artery: use of a prosthetic conduit is outdated

Pontailler

Bernard

Gaudin

et al. 2019

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Repair of tetralogy of Fallot (ToF) can be challenging in the presence of an abnormal coronary artery (CA) in 5–12% of cases. The aim of this study was to report our experience with ToF repair without the systematic use of a right ventricle-to-pulmonary artery (RV-PA) conduit. METHODS We conducted a monocentric retrospective study from 2000 to 2016, including 943 patients with ToF who underwent biventricular repair, of whom 8% (n = 76) presented with an abnormal CA. Mean follow-up time was 50 months (1 month–18 years). RESULTS The most frequent CA anomaly was the left descending artery arising from the right CA (n = 47, 61.8%). The median age at repair was 7.7 months (1.8 months–16 years). Thirteen patients (17%) required prior palliation, mostly systemic pulmonary shunts for anoxic spells in the neonatal period. Surgical repair allowed us to preserve the annulus in 40 patients (53%) by combining PA trunk plasty, commissurotomy and infundibulotomy under the abnormal CA. If the annulus had to be opened (n = 35, 46%), a transannular patch was inserted after a vertical incision of the PA trunk and extended obliquely on the RV over the anomalous crossing CA (with an infundibulotomy under the abnormal CA). Three patients (4%) required the insertion of an RV-PA conduit (1 valved tube and 2 RV-PA GORE-TEX tubes with annulus conservation). The early mortality rate was 4% (n = 3); none of the deaths was coronary related. Four patients (5%) required reoperation (2 early and 2 late reoperations) for residual pulmonary stenosis, 3 of whom had annulus preservation during the initial repair. The mean RV/left ventricle (LV) pressure ratio and an RV/LV pressure ratio >2/3 were identified as risk factors for right ventricular outflow tract (RVOT) reinterventions (P = 0.0026, P = 0.0085, respectively), RVOT reoperations (P = 0.0002 for both) and reoperation for RVOT residual stenosis (P = 0.0002, P = 0.0014, respectively). Two patients underwent pulmonary valve replacement. Freedom from late reoperation was 100% at 1 year, 97% at 5 years and 84% at 10 and 15 years. CONCLUSIONS Repair of ToF and abnormal CA can be performed without an RV-PA conduit, with an acceptable low reintervention rate. The high early mortality rate in this series remains a concern. If any doubt remains about the surgical relief of the RVOT obstruction, the RV/LV pressure ratio should always be measured in the operating room.

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“…arter anomalileri bu grup hastaların %5'inde görülür (16,17). Cerrahi prosedürü en sık etkileyen anomali, sol ön inen koroner arterin anormal olarak sağ koroner arterden çıkıp sağ ventrikül çıkım yolunu çaprazlayarak seyretmesidir (17,18). Hastalarımızdan 1 tanesinde sol koroner arterin sağdan çıktığını gözlemledik sağ ventrikül çıkım yolunu çaprazlamadığı için cerrahi açıdan risk oluşturmadı.…”

Section: Koronerunclassified

Fallot Tetralojili olguların Preoperatif Değerlendirilmesinde BT Anjiyografinin önemi; Tek merkez deneyimi

Demircan

Işık

Akyüz

et al. 2019

Osmangazi̇ Journal of Medicine

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Özet: Çalışmamızda Fallot tetralojili olgularda koroner ve pulmoner arter anomalileri ve eşlik eden ekstrakardiyak malformasyonların değerlendirilmesinde Bilgisayarlı Tomografi (BT) anjiyografinin tanısal önemi araştırıldı. Ayrıca operasyon öncesi çekilen BT anjiyografinin cerrahi açıdan faydalarını değerlendirmeyi amaçladık. Ocak 2016-Ocak 2018 tarihleri arasında Fallot tetralojisi (pulmoner kapak yokluklu ve pulmoner atrezili dahil) tanısı konulan olguların dosyaları geriye dönük olarak incelendi. Bilgisayarlı Tomografi anjiyografi çekilmemiş olanlar ve dosyasında eksik veri bulunanlar çalışmaya dahil edilmedi. Hastaların yaşı, cinsiyeti, operasyon yaşı, ekokardiyografi, BT anjiyografi ve operasyon sonuçları değerlendirildi. Toplam 32 hasta çalışmaya alındı. Ortalama yaşları 18±17 (1-84) ay idi. 32 hastanın 6'sında pulmoner kapak atrezili ve 1 olguda pulmoner kapak yokluklu Fallot tetralojisi vardı. BT anjiyografi ile saptadığımız ekstrakardiyak malformasyonlar 6 olguda aortopulmoner kolleteral arter, 2 olguda retroaortik seyirli inominate ven,1 olguda aberran sağ subklavian arter ve 1olguda koroner arter anomalisi idi. Fallot tetralojili hastalarda pulmoner arterlerin konfluensi, çapları ve aortopulmoner kolleteral arter gibi vasküler yapıları göstermede BT anjiyografi önemlidir. Bu inceleme cerrahi seçimi ve yaklaşım açısından belirgin fayda sağlamaktadır.

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Detection of pulmonary and coronary artery anomalies in tetralogy of Fallot using non-ECG-gated CT angiography

Abstract: Due to its reduced scanning time and high spatial resolution, non-ECG-gated CT angiography is a non-invasive imaging modality that provides accurate information on pulmonary and coronary artery anatomy in patients with TOF.

Cited by 22 publications

References 32 publications

Coronary anomalies in tetralogy of Fallot – A meta-analysis

Coronary anomalies in tetralogy of Fallot – A meta-analysis

Tetralogy of Fallot and abnormal coronary artery: use of a prosthetic conduit is outdated

Fallot Tetralojili olguların Preoperatif Değerlendirilmesinde BT Anjiyografinin önemi; Tek merkez deneyimi

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