Total correction in tetralogy of Fallot with anomalous major coronary artery: an alternative method to conduit use

A coronary artery anomaly precludes the use of a trans-annular patch in right ventricular outflow tract (RVOT) reconstruction. Herein we present three patients with coronary artery anomalies who underwent total corrective operations without using a conduit. Between 2007 and 2010, 84 patients with te...

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Bibliographic Details
Published in:	Cardiovascular Journal of Africa Vol. 23; no. 2; pp. e8 - e10
Main Authors:	Saritas, B, Ozker, E, Vuran, E, Yoruker, U, Ayabakan, C, Turkoz, R
Format:	Journal Article
Language:	English
Published:	South Africa 12-03-2012
Subjects:	Blalock-Taussig Procedure Cardiopulmonary Bypass - methods Child Child, Preschool Coronary Vessel Anomalies - complications Coronary Vessel Anomalies - surgery Echocardiography Feasibility Studies Female Follow-Up Studies Humans Male Recovery of Function Tetralogy of Fallot - complications Tetralogy of Fallot - surgery Ventricular Outflow Obstruction - etiology Ventricular Outflow Obstruction - surgery
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Summary:	A coronary artery anomaly precludes the use of a trans-annular patch in right ventricular outflow tract (RVOT) reconstruction. Herein we present three patients with coronary artery anomalies who underwent total corrective operations without using a conduit. Between 2007 and 2010, 84 patients with tetralogy of Fallot (TOF) were operated on. Nine (9.4%) of them had a coronary artery anomaly. Three (3.1%) of the patients were operated on using the double-outflow technique and two had a Blalock-Taussig shunt before the total corrective operation. In two patients, the left anterior descending artery (LAD) and in one, the right coronary artery (RCA) crossed the RVOT. Postoperatively, the right-to-left ventricular pressure ratios were 0.45, 0.59 and 0.60 after cardiopulmonary bypass. No gradient was detected in the RVOT in postoperative echocardiographical measurements (< 15 mmHg gradient). In all three patients, there were moderate pulmonary insufficiencies. All were discharged home on the sixth day postoperatively. Mean follow-up duration was 9.8 ± 8 months. In the follow up of all three patients, there were moderate pulmonary insufficienciencies but no right ventricular dysfunction. The 'double-outflow' technique is appropriate for TOF patients with a major coronary artery anomaly since it can easily be performed without the need of a conduit.
ISSN:	1995-1892 1680-0745
DOI:	10.5830/CVJA-2011-004