Evaluation of coronary artery anatomy in patients with tetralogy of Fallot by two-dimensional echocardiography.

Abstract

A major coronary artery crossing the right ventricular outflow tract in patients with tetralogy of Fallot interferes with a transannular patch, and preoperative detection of this artery is important. We evaluated the ability of two-dimensional echocardiography to define noninvasively the coronary artery anatomy in 37 consecutive patients (age range, 1 day to 18 years; mean age, 40.9 months). The origin and distribution of the right anterior descending and circumflex coronary arteries, as well as any anteriorly coursing vessel, were examined from parasternal views. Complete studies were obtained in 29 (78%) of the 37 patients. Coronary artery anatomy was determined to be normal by echocardiography in 20 (69%) of the 29 patients. An anterior vessel across the right ventricular outflow tract was detected in the remaining nine patients. Six patients had an anterior descending artery from the left main coronary artery (paired anterior descending arteries in three patients, a right anterior descending artery from the left main coronary artery in two patients, and a right coronary-topulmonary artery fistula in one patient). Three patients had no anterior descending artery from the left main coronary artery (anterior descending artery from the right main coronary artery in two patients, and anterior descending and circumflex arteries from the right main coronary artery in one patient). Angiography, surgery, or autopsy confirmed the diagnoses in all but the final patient in whom the anterior descending artery arose from the right main coronary artery as observed at surgery, but the circumflex artery was not seen. Accurate evaluation of coronary artery anatomy is possible by echocardiography in the majority of patients with tetralogy of Fallot. Noninvasive identification of a major coronary artery coursing anteriorly can influence the timing of cardiac catheterization and surgery and the need for angiography. (Circulation 1988;78:149-156)

Selective coronary angiography in patients younger than 1 year of age

“…However, today, the skills of the surgeons have developed to a point that this information is no longer required. Therefore, only few preoperative assessments remain necessary, such as the identification of the left anterior descending (LAD) artery in tetralogy of Fallot [9] or the first septal branch from the LAD for the Ross or Konno procedures [10]. In addition, information about the origin of coronary artery perfusion in pulmonary atresia with intact ventricular septum, especially when fistulas are identified after right ventricular angiography, is useful for making decision in the surgical management of this malformation (Fig.…”

Coronary arterial anatomy in tetralogy of Fallot: morphological and clinical correlations

“…Although there is increasing experience of echocardiographic assessment of patients with tetralogy of Fallot,26 27abnormalities of pulmonary and coronary arteries are not always identified. The sensitivity and specificity of echocardiographic diagnosis of coronary abnormalities in clinical practice is unclear 25…”

Simplified double barrel repair with autologous pericardium for tetralogy of fallot with hypoplastic pulmonary annulus and anomalous coronary crossing right ventricular outflow

“…In 5-9 % of the patients with TOF, a major coronary artery branch courses anteriorly across the right ventricular outflow tract (RVOT),[1–3] so that a transannular incision or patch would interrupt coronary blood flow. The most commonly encountered patterns are left anterior descending coronary artery (LAD) from right coronary artery (RCA), RCA from left coronary artery (LCA), RCA from LAD, large conal artery from RCA, and single RCA.…”