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Anomalies of coronary arteries in tetralogy of Fallot: Evaluation on multidetector CT angiography using dual‐source scanner
Author(s) -
Pandey Niraj Nirmal,
Bhambri Kanika,
Verma Mansi,
Jagia Priya,
Kothari Shyam Sunder,
Saxena Anita
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15572
Subject(s) - medicine , coronary arteries , tetralogy of fallot , cardiology , right coronary artery , artery , great arteries , radiology , coronary sinus , coronary angiography , angiography , heart disease , myocardial infarction
Objectives The present study sought to determine the prevalence and evaluate the patterns of various anomalies of coronary arteries in patients with tetralogy of Fallot (TOF) on multidetector CT angiography using a dual‐source CT scanner. Methods We retrospectively reviewed CT angiographies of 955 pediatric patients, diagnosed with TOF between 1st January 2015 and 31st December 2019 and having an optimal evaluation of coronary arteries, with respect to the origin, course, and termination of the coronary arteries and associated cardiovascular anomalies. Results Anomalies of coronary arteries were observed in 8.27% (79/955) patients with TOF. Origin of accessory/proper left anterior descending (LAD) artery from right coronary artery (RCA) or right coronary sinus was the most common anomalous pattern, seen in 3.14% (30/955) patients, followed by the presence of hypertrophied conal artery seen in 2.62% (25/955) patients. The anomalous coronary artery was crossing the right ventricular outflow tract (RVOT) in all cases where the LAD artery was arising from RCA or right coronary sinus or where RCA was arising from the LAD artery. Coronary arterial anomalies were seen in a significantly higher proportion of patients with an atrial septal defect compared to those without (7/25 [28%] vs. 72/930 [7.74%]; p = .0003). Conclusion The prevalence of anomalies of coronary arteries increases significantly in the presence of TOF as compared to the general population. Majority of these anomalous coronary arteries course anterior to the RVOT which can potentially pose technical difficulties with a risk of adverse surgical outcomes and increased morbidity and mortality, rendering their diagnosis crucial before surgery.