Coronary anomalies in tetralogy of Fallot – A meta-analysis

• Published in: International journal of cardiology 2020-05, Vol.306, p.78-85
• Main Authors: Koppel, Claire J., Jongbloed, Monique R.M., Kiès, Philippine, Hazekamp, Mark G., Mertens, Bart J.A., Schalij, Martin J., Vliegen, Hubert W.
• Format: Article
• Language: English
• Subjects: Anomalous coronary artery; Conus artery; Coronary arteriovenous fistula; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessel Anomalies - epidemiology; Coronary Vessel Anomalies - surgery; Heart Ventricles; Humans; London; Right ventricular outflow tract; Tetralogy of Fallot; Tetralogy of Fallot - diagnostic imaging; Tetralogy of Fallot - epidemiology; Tetralogy of Fallot - surgery
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2020.02.037

An anomalous coronary artery is reported in 2% to 23% of patients with tetralogy of Fallot (TOF). Knowledge of coronary anatomy prior to corrective surgery is vital to avoid damage to vessels crossing the right ventricular outflow tract (RVOT). A meta-analysis on the prevalence of anomalous coronary arteries in TOF is lacking to date. Here, an overview of coronary anomalies in TOF is provided and implications for patient management are discussed. PubMed, Embase and Web of Science were searched. Analysis was done using Revman 5.3 (Cochrane Community, London). The primary analysis focused on the origin and proximal course of the right and left coronary arteries. In addition, the prevalence of large conus arteries and coronary arteriovenous fistulas (CAVF) was calculated. Twenty-eight studies, encompassing 6956 patients, were included; 6% of TOF patients have an anomalous coronary artery. Hereof, 72% cross the RVOT; the majority of the remaining 28% courses behind the aorta. Six percent of patients have a large conus artery and 4% a CAVF. Other coronary anomalies include a left or right coronary artery from the pulmonary trunk or left or right pulmonary artery, coronary tree hypoplasia and anastomoses between coronary and bronchial arteries. The prevalence of coronary anomalies in TOF is 4–6%. In patients with an anomalous coronary artery, 72% cross the RVOT. The combined risk of encountering an anomalous coronary artery or a large conus artery crossing the RVOT is 10.3%. Coronary anatomy should be defined before surgery and the surgical approach adapted accordingly. [Display omitted] •The prevalence of coronary anomalies in TOF is 4–6%.•In patients with an ACA, 72% of the anomalous arteries cross the RVOT.•The risk of encountering an ACA or large conus artery crossing the RVOT is 10.3%.•Before surgery, define the coronary anatomy to avoid damage of anomalous vessel.•Surgical approach should be adapted to the course of an anomalous coronary artery.