Heart 1998;80:174-183 ( August )
Coronary arterial anatomy in tetralogy of Fallot: morphological and clinical correlations
a Paediatrics,
Imperial College School of Medicine at National Heart and Lung
Institute, Dovehouse Street, London SW3 6LY, UK, b Paediatric Cardiology Department, Royal
Brompton Hospital, London, UK
Correspondence to: Dr Yen Ho.
Accepted for publication 1 April 1998
Objective
To
clarify the problems in angiographic diagnosis of major coronary
arteries crossing the right ventricular outflow tract.
DesignA
retrospective study with clinicomorphological correlations to
ascertain any aberrant coronary arteries and variations in distribution
of the normal right coronary arterial branches.
SettingTertiary
referral centre.
Subjects36
necropsy specimens together with the aortograms and surgical reports
from 130 patients with tetralogy of Fallot.
ResultsA
preventricular branch was found in 19% of cases with tetralogy of
Fallot, but in none of 13 normal hearts. Aberrant origin of the
anterior interventricular coronary artery was found in 14% of the
specimens. The combination of "laid back" and straight lateral
views, when reviewed retrospectively, identified this anomaly correctly
in nine of 16 patients, with these findings confirmed at surgery in
seven patients. A major branch initially thought to cross the outflow
tract was shown retrospectively to be an infundibular artery in six,
with surgical confirmation in four. It was a preventricular branch in
another patient.
ConclusionsUsing
the laid back view alone, infundibular and preventricular branches may
be mistaken for a major aberrant artery. A combination of laid back and
straight lateral views is needed to avoid false positive diagnosis.
© 1998 by Heart
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