END-ON AORTOGRAM - IMPROVED IDENTIFICATION OF IMPORTANT CORONARY-ARTERY ANOMALIES IN TETRALOGY OF FALLOT

Objective-To identify coronary artery anomalies in patients with tetra logy of Fallot with an aortogram taken with steep caudal and left obli que angulation (''end-on'' aortogram). Design-Prospective evaluation o f end-on aortogram in the preoperative angiographic assessment of cons ecutive patients with tetralogy of Fallot. Setting-Regional paediatric cardiology centre. Patients-34 patients, aged 3 months to 12 years (m edian age 9 months). Methods-An aortogram was performed with steep cau dal (38 degrees-45 degrees) and left oblique (0 degrees-30 degrees) an gulation under general anaesthetic as part of routine preoperative ang iographic assessment. Results-The origins and courses of the coronary arteries were visualised in all patients and important coronary artery anomalies were identified in four patients: single left coronary arte ry; single right coronary artery (two patients); separate high origin of left anterior descending. These anomalous coronary vessels crossed the right ventricular outflow tract. Conclusions-It is important to id entify preoperatively coronary arteries that may interfere with right ventricular outflow tract reconstruction. An aortogram with steep caud al and left oblique angulation is useful in identifying anomalous coro nary arteries and more importantly it defines the relation of these ve ssels to the right ventricular outflow tract.