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Romeih S, Kaoud A, Shaaban M, Elzoghaby M, Abdelfattah M, Hashem M, Sayed S, Gibreel M, Elmozy W. Coronary artery anomalies in tetralogy of Fallot patients evaluated by multi slice computed tomography; myocardial bridge is not a rare finding. Medicine (Baltimore) 2021; 100:e24325. [PMID: 33607768 PMCID: PMC7899912 DOI: 10.1097/md.0000000000024325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023] Open
Abstract
Based on coronary angiography and interoperative inspection, anomalous origin of coronary artery crossing the right ventricular outflow tract (RVOT) is common in tetralogy of Fallot (TOF) patients. However, other coronary anomalies may be underestimated due to the overlying myocardium, epicardial fat, or adhesions due to previous palliative surgery. Currently, coronary artery visibility dramatically improved by multislice computed tomography (MSCT). We performed this study to assess the coronary arteries anatomy in TOF patients using MSCT.All TOF patients underwent MSCT examination at our centre from 2013 till 2019 were included. Assessment of the coronary arteries' origin and course were performed. Presence of myocardial bridge were assessed, and indexed RV mass was calculated.318 TOF patients were included, median age 2 years (range 1 month-46 years), 175 males (55%). The abnormal coronary artery origin and course were detected in 20 patients (6%); coronary artery crossed RVOT in 13 patients (65%), 5 patients (25%) had a retro-aortic course and 2 patient (10%) had inter-arterial course. Myocardial bridges of left anterior descending artery or/and right coronary artery were reported in 100 patients (36%), no myocardial bridge of left circumflex was reported. RV mass was 29.0 ± 21.1 g/m2. There was no correlation between RV mass and presence of myocardial bridges.MSCT is a useful imaging modality for detection of coronary arteries anomalies in TOF patients. Coronary artery crossing RVOT is not the only abnormal course and myocardial bridging is not a rare finding. Further studies are needed to demonstrate the clinical significance of these observations.
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Affiliation(s)
- Soha Romeih
- Department of Radiology, Aswan Heart Centre, Aswan
- Department of Cardiology, Tanta University, Tanta
| | - Alaa Kaoud
- Department of Anatomy and Embryology, Asyut University, Asyut
| | - Mahmoud Shaaban
- Department of Radiology, Aswan Heart Centre, Aswan
- Department of Cardiology, Tanta University, Tanta
| | - Mohamed Elzoghaby
- Department of Radiology, Aswan Heart Centre, Aswan
- Department of Cardiology, Tanta University, Tanta
| | - Mohamed Abdelfattah
- Department of Radiology, Aswan Heart Centre, Aswan
- Department of Radiology, Al-Azhar University
| | - Mohamed Hashem
- Department of Anatomy and Embryology, Asyut University, Asyut
| | - Sayed Sayed
- Department of Anatomy and Embryology, Asyut University, Asyut
| | | | - Wesam Elmozy
- Department of Radiology, Aswan Heart Centre, Aswan
- Department of Radiology, Cairo University, Cairo, Egypt
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Koppel CJ, Jongbloed MR, Kiès P, Hazekamp MG, Mertens BJ, Schalij MJ, Vliegen HW. Coronary anomalies in tetralogy of Fallot – A meta-analysis. Int J Cardiol 2020; 306:78-85. [DOI: 10.1016/j.ijcard.2020.02.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/30/2020] [Accepted: 02/14/2020] [Indexed: 10/25/2022]
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Coronary artery anomalies on preoperative cardiac CT in children with tetralogy of Fallot or Fallot type of double outlet right ventricle: comparison with surgical findings. Int J Cardiovasc Imaging 2018; 34:1997-2009. [DOI: 10.1007/s10554-018-1422-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
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Chowdhury UK, Patel K, Gupta SK, Jagia P, Singh SP. Right Coronary Artery to Pulmonary Arterial Fistula Associated With Tetralogy of Fallot. World J Pediatr Congenit Heart Surg 2015; 6:654-7. [DOI: 10.1177/2150135115581385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 16-year-old boy with tetralogy of Fallot (TOF), pulmonary stenosis, and coronary artery to pulmonary arterial fistulous communication arising from the proximal right coronary artery is reported for its rarity. The surgical importance of this anomaly is highlighted. The diagnosis should be borne in cases of TOF, with echocardiographic demonstration of severe right ventricular outflow tract obstruction without a corresponding degree of systemic arterial desaturation.
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Affiliation(s)
- Ujjwal K. Chowdhury
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Kartik Patel
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sarvesh Pal Singh
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Seetharama Bhat P, Girish Gowda S, Mahimarangaiah J, Manjunath CN. Giant coronary-pulmonary fistula with pulmonary atresia, ventricular septal defect, and coronary anomaly: A case report and review of literature. Ann Pediatr Cardiol 2014; 7:142-4. [PMID: 24987263 PMCID: PMC4070206 DOI: 10.4103/0974-2069.132496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Congenital coronary-pulmonary artery fistula is a rare condition and is usually associated with pulmonary atresia. We present a 10-year-old girl with circumflex coronary artery to pulmonary artery (PA) fistula with a giant dilated circumflex coronary artery, ventricular septal defect (VSD), pulmonary atresia, and anomalous originofleft anterior descending (LAD) artery from right coronary sinus. The patient underwent surgical correction. We report the investigation, treatment, and review of literatureof this rare congenital anomaly associated with dilated circumflex coronary artery.
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Affiliation(s)
- Ps Seetharama Bhat
- Department of Cardiothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Sl Girish Gowda
- Department of Cardiothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Jayaranganath Mahimarangaiah
- Department of Paediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
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Talwar S, Anderson RH, Keshri VK, Choudhary SK, Gulati GS, Airan B. Coronary-pulmonary artery fistula in tetralogy of Fallot with pulmonary atresia. Asian Cardiovasc Thorac Ann 2013; 22:1003-9. [DOI: 10.1177/0218492313505101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgical correction of patients with tetralogy of Fallot with pulmonary atresia is now one of the routine procedures performed by pediatric cardiac surgeons. In one variant, the pulmonary arterial supply is derived from a fistulous communication from the coronary arteries. This rare and interesting situation poses a diagnostic and therapeutic dilemma, as well as providing specific management challenges to the surgical team. Here, we discuss important aspects of this rare variant, specifically its morphology, presentation, evaluation and management.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vikas Kumar Keshri
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Mittal CM, Mohan B, Kumar R, Garg S, Grover S, Aslam N, Wander GS. A case of tetralogy of Fallot associated with left anterior descending coronary artery to pulmonary artery fistula. Ann Pediatr Cardiol 2012; 4:202-3. [PMID: 21976889 PMCID: PMC3180987 DOI: 10.4103/0974-2069.84673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Presence of coronary to pulmonary artery fistula is generally a feature of pulmonary atresia with ventricular septal defect. We present a rare case of left anterior descending coronary artery to pulmonary artery fistula in a patient of tetralogy of Fallot.
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Affiliation(s)
- Chander Mohan Mittal
- Department of Cardiovascular and Thoracic Surgery, Dayanand Medical College and Hospital, Ludhiana, India
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Taleb MM, Sheikh MA, Cooper CJ, Tinkel JL. Multiple coronary to pulmonary artery fistulas: a case report and review of the literature. Cardiovasc Interv Ther 2012; 27:127-30. [PMID: 22623009 DOI: 10.1007/s12928-012-0096-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 01/03/2012] [Indexed: 12/20/2022]
Abstract
Coronary to pulmonary artery fistulae (CAF) are rare cardiac anomalies. The majority arise from the right coronary artery, with fistulae originating from the left anterior descending artery or from multiple arteries being less common. CAF are frequently asymptomatic and found incidentally on routine cardiac imaging. We present the case of a 61-year-old woman with multiple CAF who presented with progressive shortness of breath and chest pain and was ultimately treated successfully with trans-catheter coiling with marked improvement in symptoms. We also review the currently available literature regarding advances in diagnosis and treatment of CAF.
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Affiliation(s)
- Mohammed M Taleb
- Division of Cardiovascular Medicine, University of Toledo Health Science Campus, 3000 Arlington Ave., MS 1118, Toledo, OH 43614, USA
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