The large conus artery transversing the right ventricular outflow tract may cause more confusion and concern in the surgery of tetralogy of Fallot with a small pulmonary annulus than other well-known coronary anomalies. We experienced an infantile case that precipitated into a critical left ventricular failure caused by transection of a large conus artery for the transannular right ventricular outflow tract reconstruction and rescued the patient with an extracorporeal lung–heart-assist system. Preoperative precise diagnosis of coronary anatomy should serve to protect against fatal mistakes, and various techniques for repair must be chosen individually for this subset of anomalies.
Tetralogy of Fallot Large conus artery
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Brizard, CPR, Mas, C, Sohn, YS, Cochrane, AD, Karl, TR 1998Transatrial–transpulmonary tetralogy of Fallot repair is effective in the presence of anomalous coronary arteries.J Thorac Cardiovasc Surg116770779PubMedGoogle Scholar
Dabizzi, RP, Caprioli, G, Aiazzi, L 1980Distribution and anomalies of coronary arteries in tetralogy of Fallot.Circulation6195102PubMedGoogle Scholar
Davis, JT, Teske, DW, Alien, HD, Cohen, DM, Schauer, GM 1996Anomalous course of the left main coronary artery in tetralogy of Fallot.Ann Thorac Surg61229231CrossRefPubMedGoogle Scholar
Fellows, KE, Freed, MD, Keane, JF, et al. 1975Results of routine preoperative coronary angiography in tetralogy of Fallot.Circulation51561566PubMedGoogle Scholar
Hurwitz, RA, Smith, W, King, H, Girod, DA, Caldwell, RL 1980Tetralogy of Fallot with abnormal coronary artery: 1967 to 1977.J Thorac Cardiovasc Surg80129134PubMedGoogle Scholar
Kirklin, JW, Blackstone, EH, Jonas, RA 1992Morphologic and surgical determinants of outcome even after repair of tetralogy of Fallot and pulmonary stenosis.J Thorac Cardiovasc Surg103706723PubMedGoogle Scholar
O’Sullivan, J, Bain, H, Hunter, S, Wren, C 1994End-on aortogram: improved identification of important coronary artery anomalies in tetralogy of Fallot.Br Heart J71102106PubMedGoogle Scholar
van Son, JAM 1995Repair of tetralogy of Fallot with anomalous origin of left anterior descending coronary artery.J Thorac Cardiovasc Surg110561562PubMedGoogle Scholar