TRANSATRIAL-TRANSPULMONARY TETRALOGY OF FALLOT REPAIR IS EFFECTIVE INTHE PRESENCE OF ANOMALOUS CORONARY-ARTERIES

Objectives: The study's object was to analyze the outcomes of transatr ial-transpulmonary repair in children with tetralogy of Fallot and ano malous coronary artery crossing the right ventricular outflow tract. M ethods: The transatrial-transpulmonary approach was used in 611 consec utive repairs, 36 (5.9%) of which were associated with a surgically re levant coronary artery anomaly The median age and weight of the patien ts at repair were 23 months (2.8-170 months) and 9.9 kg (5.2-41 kg), r espectively, Anomalies included left anterior descending coronary arte ry from right coronary artery or single right coronary artery (n = 22) , right coronary artery from left coronary artery or left anterior des cending 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 a pproach was successful in 34 cases, in 25 of which placement of a limi ted transannular patch was necessary. Two patients had a right ventric le-pulmonary artery conduit as a result of proximity of the coronary b ranch to the pulmonary arterial anulus and inability to adequately rel ieve the right ventricular outflow tract obstruction. Results: There h ave been no early or late deaths. Mean right ventricle-pulmonary arter y 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 artel ies (P = .3), Actuaria l freedom from reoperation at 120 months was 96.5% (95% confidence int erval 79.8%-99.5%) and was also similar between patients with and with out coronary artery abnormalities (P = .92). Conclusions: Surgically i mportant coronary anomalies in tetralogy of Fallot can be dealt with t hrough the transatrial-transpulmonary approach in most cases without m ajor 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 .