Tetralogy of Fallot with an abnormal coronary artery: surgical options and prognostic factors

Factors affecting perioperative mortality in tetralogy of Fallot

“…33 In cases with a preserved pulmonary annulus, high pRV/pLV may be insignificant and the measurements taken immediately after the pump may be inaccurate. Some studies also show that this ratio can drop within 24 hours.…”

Heart failure in adult congenital heart disease: Emerging concepts with a focus on tetralogy of Fallot

“…Anomalous coronary artery arrangements are present in 2-9% of TOF patients and commonly consist of a major coronary artery present in the infundibular region, which may complicate surgical intervention (common variants include left anterior descending coronary artery (LAD) from the right coronary artery [43], accessory LAD from the RCA, a major infundibular branch, or a single coronary artery). In the presence of abnormal coronary arteries, post-operative evidence of ischemia was independently associated with risk of development of HF in the longterm [44]. Acquired coronary artery disease has been documented in a small subset of adults with repaired TOF, although numbers will undoubtedly increase in parallel with improving longevity in this population.…”

Cardiovascular CT in Cyanotic Congenital Heart Disease

“…Preoperatively, most TOF anatomy can be determined by echocardiogram. However, an estimated 5% to 12% of these patients have coronary artery abnormalities, such as an accessory left anterior descending coronary arising from the right coronary and crossing the pulmonary outflow tract, which can preclude a full neonatal repair [47][48][49]. Echo may be unable to definitively assess coronary artery anatomy, but CT has been shown to identify coronary anomalies in young children with unrepaired TOF with 97% to 100% sensitivity and specificity [50,51].…”