Transatrial-transpulmonary tetralogy of Fallot repair is effective in the presence of anomalous coronary arteries

C. P R Brizard, C. Mas, Y. S. Sohn, A. D. Cochrane, T. R. Karl, John Brown, Y. Kawashima, C. Tchervenkov

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objectives: The study's object was to analyze the outcomes of transatrial-transpulmonary repair in children with tetralogy of Fallot and anomalous coronary artery crossing the right ventricular outflow tract. Methods: The transatrial-transpulmonary approach was used in 611 consecutive repairs, 36 (5.9%) of which were associated with a surgically relevant coronary artery anomaly. The median age and weight of the patients at repair were 23 months (2.8-170 months) and 9.9 kg (5.2-41 kg), respectively. Anomalies included left anterior descending coronary artery from right coronary artery or single right coronary artery (n = 22), right coronary artery from left coronary artery or left anterior descending coronary artery (n = 8), and large right coronary artery conal branch (n = 6). Diagnosis was established before the operation in 25 of 36 cases by angiography (n = 24) or echocardiography (n = 1). The approach was successful in 34 cases, in 25 of which placement of a limited transannular patch was necessary. Two patients had a right ventricle-pulmonary artery conduit as a result of proximity of the coronary branch to the pulmonary arterial anulus and inability to adequately relieve the right ventricular outflow tract obstruction. Results: There have been no early or late deaths. Mean right ventricle-pulmonary artery gradient at last follow-up was 19 mm Hg (95% confidence interval 14.5- 24 mm Hg), compared with 15 mm Hg (95% confidence interval 12.5-17.5 mm Hg) for patients with normal coronary arteries (P = .3). Actuarial freedom from reoperation at 120 months was 96.5% (95% confidence interval 79.8 %-99.5 %) and was also similar between patients with and without coronary artery abnormalities (P = .92). Conclusions: Surgically important coronary anomalies in tetralogy of Fallot can be dealt with through the transatrial- transpulmonary approach in most cases without major alterations in technique. Outcomes are similar to those of other patients with tetralogy of Fallot. The presence of anomalous coronary arteries does not impart incremental risk after this surgical strategy.

Original languageEnglish (US)
Pages (from-to)770-779
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume116
Issue number5
DOIs
StatePublished - 1998
Externally publishedYes

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Tetralogy of Fallot
Coronary Vessels
Confidence Intervals
Pulmonary Artery
Heart Ventricles
Ventricular Outflow Obstruction
Reoperation
Echocardiography
Angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Transatrial-transpulmonary tetralogy of Fallot repair is effective in the presence of anomalous coronary arteries. / Brizard, C. P R; Mas, C.; Sohn, Y. S.; Cochrane, A. D.; Karl, T. R.; Brown, John; Kawashima, Y.; Tchervenkov, C.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 116, No. 5, 1998, p. 770-779.

Research output: Contribution to journalArticle

Brizard, C. P R ; Mas, C. ; Sohn, Y. S. ; Cochrane, A. D. ; Karl, T. R. ; Brown, John ; Kawashima, Y. ; Tchervenkov, C. / Transatrial-transpulmonary tetralogy of Fallot repair is effective in the presence of anomalous coronary arteries. In: Journal of Thoracic and Cardiovascular Surgery. 1998 ; Vol. 116, No. 5. pp. 770-779.
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abstract = "Objectives: The study's object was to analyze the outcomes of transatrial-transpulmonary repair in children with tetralogy of Fallot and anomalous coronary artery crossing the right ventricular outflow tract. Methods: The transatrial-transpulmonary approach was used in 611 consecutive repairs, 36 (5.9{\%}) of which were associated with a surgically relevant coronary artery anomaly. The median age and weight of the patients at repair were 23 months (2.8-170 months) and 9.9 kg (5.2-41 kg), respectively. Anomalies included left anterior descending coronary artery from right coronary artery or single right coronary artery (n = 22), right coronary artery from left coronary artery or left anterior descending coronary artery (n = 8), and large right coronary artery conal branch (n = 6). Diagnosis was established before the operation in 25 of 36 cases by angiography (n = 24) or echocardiography (n = 1). The approach was successful in 34 cases, in 25 of which placement of a limited transannular patch was necessary. Two patients had a right ventricle-pulmonary artery conduit as a result of proximity of the coronary branch to the pulmonary arterial anulus and inability to adequately relieve the right ventricular outflow tract obstruction. Results: There have been no early or late deaths. Mean right ventricle-pulmonary artery gradient at last follow-up was 19 mm Hg (95{\%} confidence interval 14.5- 24 mm Hg), compared with 15 mm Hg (95{\%} confidence interval 12.5-17.5 mm Hg) for patients with normal coronary arteries (P = .3). Actuarial freedom from reoperation at 120 months was 96.5{\%} (95{\%} confidence interval 79.8 {\%}-99.5 {\%}) and was also similar between patients with and without coronary artery abnormalities (P = .92). Conclusions: Surgically important coronary anomalies in tetralogy of Fallot can be dealt with through the transatrial- transpulmonary approach in most cases without major alterations in technique. Outcomes are similar to those of other patients with tetralogy of Fallot. The presence of anomalous coronary arteries does not impart incremental risk after this surgical strategy.",
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T1 - Transatrial-transpulmonary tetralogy of Fallot repair is effective in the presence of anomalous coronary arteries

AU - Brizard, C. P R

AU - Mas, C.

AU - Sohn, Y. S.

AU - Cochrane, A. D.

AU - Karl, T. R.

AU - Brown, John

AU - Kawashima, Y.

AU - Tchervenkov, C.

PY - 1998

Y1 - 1998

N2 - Objectives: The study's object was to analyze the outcomes of transatrial-transpulmonary repair in children with tetralogy of Fallot and anomalous coronary artery crossing the right ventricular outflow tract. Methods: The transatrial-transpulmonary approach was used in 611 consecutive repairs, 36 (5.9%) of which were associated with a surgically relevant coronary artery anomaly. The median age and weight of the patients at repair were 23 months (2.8-170 months) and 9.9 kg (5.2-41 kg), respectively. Anomalies included left anterior descending coronary artery from right coronary artery or single right coronary artery (n = 22), right coronary artery from left coronary artery or left anterior descending coronary artery (n = 8), and large right coronary artery conal branch (n = 6). Diagnosis was established before the operation in 25 of 36 cases by angiography (n = 24) or echocardiography (n = 1). The approach was successful in 34 cases, in 25 of which placement of a limited transannular patch was necessary. Two patients had a right ventricle-pulmonary artery conduit as a result of proximity of the coronary branch to the pulmonary arterial anulus and inability to adequately relieve the right ventricular outflow tract obstruction. Results: There have been no early or late deaths. Mean right ventricle-pulmonary artery gradient at last follow-up was 19 mm Hg (95% confidence interval 14.5- 24 mm Hg), compared with 15 mm Hg (95% confidence interval 12.5-17.5 mm Hg) for patients with normal coronary arteries (P = .3). Actuarial freedom from reoperation at 120 months was 96.5% (95% confidence interval 79.8 %-99.5 %) and was also similar between patients with and without coronary artery abnormalities (P = .92). Conclusions: Surgically important coronary anomalies in tetralogy of Fallot can be dealt with through the transatrial- transpulmonary approach in most cases without major alterations in technique. Outcomes are similar to those of other patients with tetralogy of Fallot. The presence of anomalous coronary arteries does not impart incremental risk after this surgical strategy.

AB - Objectives: The study's object was to analyze the outcomes of transatrial-transpulmonary repair in children with tetralogy of Fallot and anomalous coronary artery crossing the right ventricular outflow tract. Methods: The transatrial-transpulmonary approach was used in 611 consecutive repairs, 36 (5.9%) of which were associated with a surgically relevant coronary artery anomaly. The median age and weight of the patients at repair were 23 months (2.8-170 months) and 9.9 kg (5.2-41 kg), respectively. Anomalies included left anterior descending coronary artery from right coronary artery or single right coronary artery (n = 22), right coronary artery from left coronary artery or left anterior descending coronary artery (n = 8), and large right coronary artery conal branch (n = 6). Diagnosis was established before the operation in 25 of 36 cases by angiography (n = 24) or echocardiography (n = 1). The approach was successful in 34 cases, in 25 of which placement of a limited transannular patch was necessary. Two patients had a right ventricle-pulmonary artery conduit as a result of proximity of the coronary branch to the pulmonary arterial anulus and inability to adequately relieve the right ventricular outflow tract obstruction. Results: There have been no early or late deaths. Mean right ventricle-pulmonary artery gradient at last follow-up was 19 mm Hg (95% confidence interval 14.5- 24 mm Hg), compared with 15 mm Hg (95% confidence interval 12.5-17.5 mm Hg) for patients with normal coronary arteries (P = .3). Actuarial freedom from reoperation at 120 months was 96.5% (95% confidence interval 79.8 %-99.5 %) and was also similar between patients with and without coronary artery abnormalities (P = .92). Conclusions: Surgically important coronary anomalies in tetralogy of Fallot can be dealt with through the transatrial- transpulmonary approach in most cases without major alterations in technique. Outcomes are similar to those of other patients with tetralogy of Fallot. The presence of anomalous coronary arteries does not impart incremental risk after this surgical strategy.

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