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.
Abstract: Objective To summarize the experience of surgical treatment of tetralogy of Fallot (TOF) with anomalous coronary artery. Methods From March 1993 to April 2006, 22 patients with TOF and anomalous coronary artery underwent repair. The resection of hypertrophied parietal, septal band and the ventricular septal defect (VSD) repairs were performed by trans-right ventricular outflow tract (RVOT) approach in 5 cases, and by transatrial approach in 17 cases, which consisted of 7 cases required a transannular patch to enlarge a pulmonary annulus, construction of a double barrel outlet in 6 cases, by autologous pericardium conduit (3 cases), homograft (1 case) and reflected anterior wall of the main pulmonary artery in combination with bovine pericardium (2 cases). Results There was one operative death because of the anomalous coronary artery impairment. The accessory left anterior descending artery was severed because it was mistaken for the conal arteryin 1 case, which caused failure to wean from bypass, after the left internal mammary artery was anastomosed to the accessory left anterior descending artery, the cardiopulmonary bypass (CPB) was stopped successfully. Mean early gradient(ΔP) was 23.4mmHg and ΔP＞20mmHg in 9 cases. Eighteen cases were followed up, mean time was 13.2 months. Late ΔP＞20mmHg in 7 cases, and ΔP were less than 20mmHg in 11 cases. Conclusion The repair of TOF with anomalous coronary artery is more safe by using the transatrial approach. The surgical reconstruction of RVOT depends on the anatomic characteristic of anomalous coronary artery.
Abstract: Objective To analyze the surgical treatment of tetralogy of Fallot (TOF) with anomalous coronary artery (ACA) crossing the right ventricular outflow tract (RVOT), in order to improve the outcome of the disease. Methods The clinical data of 26 patients of TOF with ACA crossing the RVOT of Fu Wai Hospital from Oct.1996 to Feb.2006 were analyzed retrospectively. A double ventriculotomy superior and inferior to ACA were used in 11 patients, one ventriculotomy inferior to ACA were used in 6 patients and superior to ACA for 4 patients, 2 patients needed extra cardiac conduits, and 3 patients received other approaches. Results There were 2 operative death （7.7%）and no late deaths. Follow-up was extended 1 to 100 months, all of them had no residual ventricular septal defect(VSD) and their right ventriclepulmonary artery gradient were 27.3±15.6 mmHg. Conclusion Preoperative identification of ACA in patients with TOF is necessary. The surgeon should be careful in inspection of distribution of coronary artery during operation, and undergo the individualized surgical procedures based on the extent of RVOT obstruction and distribution of the ACA.