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Ajaja MR, Cheikh A, Rhazali H, Bouatia M, Slaoui A, Abouqal R, El Hassani A, Cheikhaoui Y. Prevalence and management of coronary artery anomalies in tetralogy of Fallot at Cheikh Zaid Hospital's Pediatric Cardiac Surgery Department in Morocco: retrospective study. Pan Afr Med J 2019; 34:157. [PMID: 32153697 PMCID: PMC7046097 DOI: 10.11604/pamj.2019.34.157.15424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/08/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Tetralogy of Fallot (TOF) is one of the most common cyanogenic congenital heart defects. It represents 10% of congenital heart diseases in children. Coronary artery anomalies (CAA) have been reported in 2% to 14% of cases in patients with TOF, according to angiographic, surgical and autopsy series. Many of these anomalies are difficult to detect during surgery. The objective of this article is to study the prevalence of the coronary artery anomalies in patients with TOF as well as their surgical management in our hospital between 2007 and 2015. METHODS A retrospective study was conducted on 90 patients with TOF aged 1 month to 10 years who were operated on in the Department of Paediatric Cardiac Surgery of Cheikh Zaid Hospital between 2007 and 2015. None of the patients had preoperative coronary angiography and all the anomalies were diagnosed during surgery. Patient clinical data were collected from patient records and from the hospital information system. The qualitative variables are expressed as mean and standard deviation and the quantitative variables are expressed as a percentage. Statistical analyses were performed using SPSS 13.0 software. RESULTS Of the 90 patients with TOF followed in the study period, 9 (10%) patients had coronary artery anomalies. We found in 3 (33%) patients an anomalous origin of the left anterior descending coronary artery (LAD) from the right coronary artery (RCA), an anomalous origin of the RCA from the left coronary trunk (LCT) in 1 (11%) patient and a large infundibular branch blocking the pulmonary infundibulum in 5 (56%) patients. All the patients underwent a complete surgical treatment (closure of the ventricular septal defect (VSD) by patch plus stenosis resection plus infundibular enlargement by patch). Eight (89%) patients progressed well in postoperative care and 1 (11%) died immediately after surgery in intensive care. CONCLUSION The coronary anomalies detected in patients with TOF are rare but represent a challenge for the surgical team because of the difficulty of diagnosing them pre-operatively. The management of these anomalies is mainly surgical and the technique used by our team is proved to be safe and effective.
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Affiliation(s)
- Mohamed Rida Ajaja
- Department of Cardiac Surgery, Cheikh Zaid Hospital, Abulcasis University, Rabat, Morocco
| | - Amine Cheikh
- Department of Pharmacy, Cheikh Zaid Hospital, Abulcasis University, Faculty of Pharmacy, Rabat, Morocco
| | - Hicham Rhazali
- Department of Intensive Care, Cheikh Zaid Hospital, Rabat, Morocco
| | - Mustapha Bouatia
- Pediatrics Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Anas Slaoui
- Department of Cardiac Surgery, Cheikh Zaid Hospital, Abulcasis University, Rabat, Morocco
| | - Redouane Abouqal
- Laboratory of Epidemiology and Clinical Research, Mohammed V University, Rabat, Morocco
| | - Amine El Hassani
- Department of Pediatrics, Cheikh Zaid Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Younes Cheikhaoui
- Department of Cardiac Surgery, Cheikh Zaid Hospital, Abulcasis University, Rabat, Morocco
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Krishna SN, Hasija S, Chauhan S, Kaushal B, Chowdhury UK, Bisoi AK, Khan MA. Can Echocardiographic Right Ventricular Function Parameters Predict Vasoactive Support Requirement After Tetralogy of Fallot Repair? J Cardiothorac Vasc Anesth 2019; 33:2404-2413. [DOI: 10.1053/j.jvca.2019.01.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Indexed: 12/15/2022]
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Pontailler M, Bernard C, Gaudin R, Moreau de Bellaing A, Mostefa Kara M, Haydar A, Barbanti C, Bonnet D, Vouhé P, Raisky O. Tetralogy of Fallot and abnormal coronary artery: use of a prosthetic conduit is outdated. Eur J Cardiothorac Surg 2019; 56:94-100. [DOI: 10.1093/ejcts/ezz030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/24/2018] [Accepted: 12/29/2018] [Indexed: 11/13/2022] Open
Abstract
AbstractOBJECTIVESRepair of tetralogy of Fallot (ToF) can be challenging in the presence of an abnormal coronary artery (CA) in 5–12% of cases. The aim of this study was to report our experience with ToF repair without the systematic use of a right ventricle-to-pulmonary artery (RV-PA) conduit.METHODSWe conducted a monocentric retrospective study from 2000 to 2016, including 943 patients with ToF who underwent biventricular repair, of whom 8% (n = 76) presented with an abnormal CA. Mean follow-up time was 50 months (1 month–18 years).RESULTSThe most frequent CA anomaly was the left descending artery arising from the right CA (n = 47, 61.8%). The median age at repair was 7.7 months (1.8 months–16 years). Thirteen patients (17%) required prior palliation, mostly systemic pulmonary shunts for anoxic spells in the neonatal period. Surgical repair allowed us to preserve the annulus in 40 patients (53%) by combining PA trunk plasty, commissurotomy and infundibulotomy under the abnormal CA. If the annulus had to be opened (n = 35, 46%), a transannular patch was inserted after a vertical incision of the PA trunk and extended obliquely on the RV over the anomalous crossing CA (with an infundibulotomy under the abnormal CA). Three patients (4%) required the insertion of an RV-PA conduit (1 valved tube and 2 RV-PA GORE-TEX tubes with annulus conservation). The early mortality rate was 4% (n = 3); none of the deaths was coronary related. Four patients (5%) required reoperation (2 early and 2 late reoperations) for residual pulmonary stenosis, 3 of whom had annulus preservation during the initial repair. The mean RV/left ventricle (LV) pressure ratio and an RV/LV pressure ratio >2/3 were identified as risk factors for right ventricular outflow tract (RVOT) reinterventions (P = 0.0026, P = 0.0085, respectively), RVOT reoperations (P = 0.0002 for both) and reoperation for RVOT residual stenosis (P = 0.0002, P = 0.0014, respectively). Two patients underwent pulmonary valve replacement. Freedom from late reoperation was 100% at 1 year, 97% at 5 years and 84% at 10 and 15 years.CONCLUSIONSRepair of ToF and abnormal CA can be performed without an RV-PA conduit, with an acceptable low reintervention rate. The high early mortality rate in this series remains a concern. If any doubt remains about the surgical relief of the RVOT obstruction, the RV/LV pressure ratio should always be measured in the operating room.
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Affiliation(s)
- Margaux Pontailler
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Chloé Bernard
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Régis Gaudin
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Anne Moreau de Bellaing
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Mansour Mostefa Kara
- Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Ayman Haydar
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Claudio Barbanti
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Damien Bonnet
- Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Pascal Vouhé
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Olivier Raisky
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
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Kalfa DM, Serraf AE, Ly M, Le Bret E, Roussin R, Belli E. Tetralogy of Fallot with an abnormal coronary artery: surgical options and prognostic factors. Eur J Cardiothorac Surg 2012; 42:e34-9. [DOI: 10.1093/ejcts/ezs367] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Luo WJ, Huang RM, Tang Y, Li B. Right coronary artery translocation in tetralogy of Fallot. Asian Cardiovasc Thorac Ann 2008; 16:73-5. [PMID: 18245713 DOI: 10.1177/021849230801600119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a simple and cost-effective technique to repair anomalous origin of the right coronary artery from the left coronary artery in tetralogy of Fallot. The proximal right coronary artery is re-implanted into the aorta after it is mobilized and transected. This technique avoids the use of conduits in infants or adults with tetralogy of Fallot and anomalous right coronary arteries, and maintains the growth potential of the translocated native coronary artery.
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Affiliation(s)
- Wan-Jun Luo
- Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha 410008, Hunan, China.
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