Surgical Treatment of Tetralogy of Fallot with Anomalous Coronary Artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIN Jing , TAO Liang , ZHOU Hong , ZENG Xiangjun , WU Xiangyang , ZHOU Dan.

Department of Cardiothoracic Surgery， Wuhan Asia Heart Hospital， Wuhan 430022， P. R. China;

Corresponding author：

Keywords：

Tetralogy of Fallot; 　Anomalous coronary artery; 　Surgery

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Abstract： Objective To summarize our surgical experience of tetralogy of Fallot（TOF） with anomalous coronary artery（ACA）， explore diagnostic method of ACA， and evaluate surgical strategy choices and clinical outcomes of right ventricular outflow tract（RVOT） reconstruction. Methods From January 2004 to January 2010， 29 patients with TOF and ACA underwent total correction in Wuhan Asia Heart Hospital. There were 18 male patients and 11 female patients with their median age of 7 years （5 months to 33 years）and median body weight of 18 （5 to 51） kg at operation. Their preoperative arterial oxygen saturation was 65%-91%. One patient underwent RVOT enlargement and repair of ventricular septal defect via right atrial approach. Three patients underwent RVOT enlargement， repair of ventricular septal defect and main pulmonary artery enlargement using autologous pericardium patch via right atrial approach. Three patients received pulmonary artery translocation （REV） technique. Five patients received double outlet technique. Eleven patients underwent RVOT enlargement via incisions above， below or beside coronary arteries （single patch or two patch technique）. Six patients underwent RVOT reconstruction using trans-annular patch after coronary artery bypass grafting. Results　 The median cardiopulmonary bypass time was 78 （65-102） min， median aortic crossclamp time was 50（40-82） min， and median operation time was 150 （126-178） min. There was no early death or severe coronary artery injury. Two　 patients underwent reexploration because of postoperative bleeding. Two patients had low cardiac output and were both cured with inotropic support. The median follow-up period was 51 （21-83）months and there was no late death during　 follow-up. All the patients were in New York Heart Association （NYHA） classⅠduring follow-up， their left ventricular ejection fraction was normal， there was no sign of myocardial ischemia in electrocardiogram， and their arterial oxygen saturation was 96%-99%.Mean early RVOT gradient （△P） was 19 （8-38） mm Hg， and the RVOT gradient （△P） did not increase during follow-up. Conclusion Preoperative diagnosis of ACA in TOF patients can be made by 64-slice multislice compute tomography （64-MSCT）. Proper surgical strategy for RVOT reconstruction should be chosen according to the distribution of coronary arteries to achieve satisfactory surgical outcomes.

Citation： JIN Jing,TAO Liang,ZHOU Hong,ZENG Xiangjun,WU Xiangyang,ZHOU Dan.. Surgical Treatment of Tetralogy of Fallot with Anomalous Coronary Artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 54-58. doi: Copy

1.	Brizard CP， Mas C， Sohn YS， et al. Transatrial-transpulmonary tetralogy of Fallot repair is effective in the presence of anomalous coronary arteries. J Thorac Cardiovasc Surg， 1998， 116 （5）：770-779.
2.	Kalra S， Sharma R， Choudhary SK， et al. Right ventricular outflow tract after non-conduit repair of tetralogy of Fallot with coronary anomaly. Ann Thorac Surg， 2000， 70 （3）：723-726.
3.	Hurwitz RA， Smith W， King H， et al. Tetralogy of fallot with　 abnormal coronary artery：1967 to 1977. J Thorac Cardiovasc Surg， 1980， 80 （1）：129-134.
4.	Husain AK， Khandeparkar JM， Tendolkar AG， et al. Surgical management of tetralogy of Fallot with anomalous coronary artery. J Postgrad Med， 1991， 37 （3）：148-151.
5.	Fellows KE， Freed MD， Keane JF， et al. Results of routine　 preoperative coronary angiography in tetralogy of Fallot. Circulation， 1975， 51 （3）：561-566.
6.	Need LR， Powell AJ， del Nido P， et al. Coronary echocardiography in tetralogy of fallot：diagnostic accuracy， resource utilization and surgical implications over 13 years. J Am Coll Cardiol， 2000， 36 （4）：1371-1377.
7.	Vastel-Amzallag C， Le Bret E， Paul JF， et al. Diagnostic accuracy of dual-source multislice computed tomographic analysis for the　 preoperative detection of coronary artery anomalies in 100 patients with tetralogy of Fallot. J Thorac Cardiovasc Surg， 2011， 142 （1）：120-126.
8.	安琪，赁可，陶开宇，等. 法洛四联症合并异常冠状动脉的外科治疗. 中国胸心血管外科临床杂志， 2007， 14 （1）：10-12.
9.	尹朝华，沈向东，刘迎龙，等. 法洛四联症合并异常冠状动脉外科治疗的临床分析. 中国胸心血管外科临床杂志， 2007， 14 （1）：6-9.
10.	Ruzmetov M， Jimenez MA， Pruitt A， et al. Repair of tetralogy of Fallot with anomalous coronary arteries coursing across the obstructed　 right ventricular outflow tract. Pediatr Cardiol， 2005， 26 （5）：537-542.
11.	Tchervenkov CI， Pelletier MP， Shum-Tim D， et al. Primary repair minimizing the use of conduits in neonates and infants with tetralogy　 or double-outlet right ventricle and anomalous coronary arteries.　 J Thorac Cardiovasc Surg， 2000， 119 （2）：314-323.
12.	Jacques AM， van Son MD. Repair of tetralogy of fallot with anomalous origin of left anterior descending coronary artery.J Thorac　 Cardiovasc Surg， 1995， 110 （2）：561-562.
13.	Assumpção CR， Brito Jde D， Pfeifer E， et al. Technical option on tetralogy of Fallot with abnormal coronary artery：cases report. Rev Bras Cir Cardiovasc， 2008， 23 （2）：272-275.
14.	Tao L， Zeng XJ. Right ventricular outflow tract patch reconstruction in anomalous origin of right coronary artery. Ann Thorac Surg， 2010， 89 （4）：1314-1316.
15.	Luo WJ， Huang RM， Tang Y， et al. Right coronary artery translocation in tetralogy of Fallot. Asian Cardiovasc Thorac Ann， 2008， 16 （1）：73-75.
16.	Tomar AS， Agarwal S， Singh A， et al. End to end anastomosis of an injured left anterior descending coronary artery. Ann Card Anaesth， 2010， 13 （3）：267-268.

1. 　Brizard CP， Mas C， Sohn YS， et al. Transatrial-transpulmonary tetralogy of Fallot repair is effective in the presence of anomalous coronary arteries. J Thorac Cardiovasc Surg， 1998， 116 （5）：770-779.
2. 　Kalra S， Sharma R， Choudhary SK， et al. Right ventricular outflow tract after non-conduit repair of tetralogy of Fallot with coronary anomaly. Ann Thorac Surg， 2000， 70 （3）：723-726.
3. 　Hurwitz RA， Smith W， King H， et al. Tetralogy of fallot with　 abnormal coronary artery：1967 to 1977. J Thorac Cardiovasc Surg， 1980， 80 （1）：129-134.
4. 　Husain AK， Khandeparkar JM， Tendolkar AG， et al. Surgical management of tetralogy of Fallot with anomalous coronary artery. J Postgrad Med， 1991， 37 （3）：148-151.
5. 　Fellows KE， Freed MD， Keane JF， et al. Results of routine　 preoperative coronary angiography in tetralogy of Fallot. Circulation， 1975， 51 （3）：561-566.
6. 　Need LR， Powell AJ， del Nido P， et al. Coronary echocardiography in tetralogy of fallot：diagnostic accuracy， resource utilization and surgical implications over 13 years. J Am Coll Cardiol， 2000， 36 （4）：1371-1377.
7. 　Vastel-Amzallag C， Le Bret E， Paul JF， et al. Diagnostic accuracy of dual-source multislice computed tomographic analysis for the　 preoperative detection of coronary artery anomalies in 100 patients with tetralogy of Fallot. J Thorac Cardiovasc Surg， 2011， 142 （1）：120-126.
8. 　安琪，赁可，陶开宇，等. 法洛四联症合并异常冠状动脉的外科治疗. 中国胸心血管外科临床杂志， 2007， 14 （1）：10-12.
9. 　尹朝华，沈向东，刘迎龙，等. 法洛四联症合并异常冠状动脉外科治疗的临床分析. 中国胸心血管外科临床杂志， 2007， 14 （1）：6-9.
10. 　Ruzmetov M， Jimenez MA， Pruitt A， et al. Repair of tetralogy of Fallot with anomalous coronary arteries coursing across the obstructed　 right ventricular outflow tract. Pediatr Cardiol， 2005， 26 （5）：537-542.
11. 　Tchervenkov CI， Pelletier MP， Shum-Tim D， et al. Primary repair minimizing the use of conduits in neonates and infants with tetralogy　 or double-outlet right ventricle and anomalous coronary arteries.　 J Thorac Cardiovasc Surg， 2000， 119 （2）：314-323.
12. 　Jacques AM， van Son MD. Repair of tetralogy of fallot with anomalous origin of left anterior descending coronary artery.J Thorac　 Cardiovasc Surg， 1995， 110 （2）：561-562.
13. 　Assumpção CR， Brito Jde D， Pfeifer E， et al. Technical option on tetralogy of Fallot with abnormal coronary artery：cases report. Rev Bras Cir Cardiovasc， 2008， 23 （2）：272-275.
14. 　Tao L， Zeng XJ. Right ventricular outflow tract patch reconstruction in anomalous origin of right coronary artery. Ann Thorac Surg， 2010， 89 （4）：1314-1316.
15. 　Luo WJ， Huang RM， Tang Y， et al. Right coronary artery translocation in tetralogy of Fallot. Asian Cardiovasc Thorac Ann， 2008， 16 （1）：73-75.
16. 　Tomar AS， Agarwal S， Singh A， et al. End to end anastomosis of an injured left anterior descending coronary artery. Ann Card Anaesth， 2010， 13 （3）：267-268.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment of Tetralogy of Fallot with Anomalous Coronary Artery

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