Coronary anomalies in TOF (Tetralogy of Fallot)

Coronary anomalies in TOF

Coronary anomalies in TOF (Tetralogy of Fallot): Coronary anomalies can occur in five to fourteen percent of patients in TOF (Tetralogy of Fallot). Coronary anomalies in tetralogy of Fallot assume significance because they may be divided during right ventriculotomy for repair. This can cause significant morbidity and even mortality. Though preoperative coronary visualisation by angiography was done more frequently earlier, it is done less often now because repair of anomalies detected on the table is feasible now. A study by Manouchehr Hekmat, Sima Rafieyian, Mahnoush Foroughi, Mohammad M Majidi Tehrani, Mahmoud Beheshti Monfared and Seyed A Hassantash [1] have found anomalies as follows: single coronary ostium in half the cases, left anterior descending coronary artery (LAD) arising from right coronary artery (RCA) in thirty seven and half percent of cases, and right coronary artery arising from the left coronary artery in about one eighth of cases. LAD may arise separately from the right sinus of Valsalva, instead of being a branch of right coronary artery. A large conal branch of right coronary artery has been reported in over sixteen percent of cases by other authors [2]. A transverse ventricular incision may help in avoiding injury to coronary arteries in surgically relevant coronary artery anomalies during repair of tetralogy of Fallot. Current day surgical risk for repair of tetralogy of Fallot may not be increased due to coronary anomalies provided they are recognized preoperatively or per operatively. Per operative detection may be obscured by a myocardial bridge, epicardial fat or adhesions in those who have undergone previous palliative surgery [3].

References

1. Manouchehr Hekmat, Sima Rafieyian, Mahnoush Foroughi, Mohammad M Majidi Tehrani, Mahmoud Beheshti Monfared, Seyed A Hassantash. Associated coronary anomalies in 135 Iranian patients with tetralogy of Fallot. Asian Cardiovasc Thorac Ann. 2005;13:307-10.
2. C P Brizard, C Mas, Y S Sohn, A D Cochrane, T R Karl. Transatrial-transpulmonary tetralogy of Fallot repair is effective in the presence of anomalous coronary arteries. J Thorac Cardiovasc Surg 1998;116:770–9.
3. R P Dabizzi, G Caprioli, L Aiazzi, C Castelli, G Baldrighi, L Parenzan, V Baldrighi. Distribution and anomalies of coronary arteries in tetralogy of fallot. Circulation. 1980; 61: 95-102.