Primary repair of tetralogy of Fallot with anomalous coronary artery

Abstract

Objective The results of repair for TOF with anomalous coronary artery(ACA) were studied to determine the incidence of coronary anomalies and evaluate surgical strategy choicesas well as postoperative outcomes. Methods From January 2008 to August 2014, 1142 consecutive patients underwent repair of TOF including 44 patients with TOF and ACA: single coronary artery in 15, dual anterior descending coronary in 15, single left anterior descending coronary arising from the rightcoronary artery in 3 and the other ACA in 5. The median age was 5.7 years(range, 1 month-27 years), and the median weight was 16.0 kg(range, 4.5-51.0 kg). Surgical procedure was selected according to the extent of right ventricular outflow tract(RVOT)obstruction and distribution of the ACA. Results There was one operative death. No deaths during the follow-up period in the other 37 patients.Single patch techniquewasperformed in 15. RVOT residual obstruction detected in 7 who without transannular patch, and one need reoperation; Two patch technique was performed in 6, and 3 of them required an additional RV-PA(pulmonary artery) tube because of RVOT residual obstruction during the operation; Double outlet technique was in 6. No tube stenosis occurred in follow-up period time; PA translocation technique was in 11. The right PA stenosis was detected in 4; ACA was ligated and divided in 3, then RVOT reconstruction was performed. Conclusion The combination of ACA is not a contraindication to primary repair of TOF. But there are many anatomiacal variations of ACA, and the accuracy of preoperative diagnosis is low. So proper selection of surgical approach should be individualized based on the careful intraoperative identification of the distribution of the ACA as well as the location and degree of the RVOT obstruction. Key words: Tetralogy of Fallot; Anomalous coronary artery; Right ventricular outflow tract reconstruction; Cardiac surgical procedures