Influence of aortopulmonary rotation on the anomalous coronary artery pattern in tetralogy of Fallot

Avoidance of injury to the coronary artery (CA) traversing the right ventri cular outflow tract during repair of the tetralogy of Fallot (TF) is possib le at the present time,(1,2) even if a preoperative diagnosis has not been made. However, for certain difficult situations, like those in which the CA takes its course just beneath the pulmonary annulus,(3,4) for an intramyoc ardial course,(4,5) and in cases of pericardial adhesion,(1,6) an accurate preoperative diagnosis by echocardiography or angiography(7,8) is helpful i f inadvertent division of the obscured CA is to be prevented. For those who plan to correct TF in early infancy, a preoperative diagnosis of an anomal ous CA is mandatory so that one can defer total correction beyond infancy.( 1,9) Although one can insert a shunt after sternotomy in these patients, it seems wiser to know the diagnosis before surgery. We propose a new classif ication of the CA pattern based on similarities in the epicardial configura tion at the base of the heart in transposition of the great arteries.(10) I t was also found that it is possible to anticipate the CA pattern from diff erences in aortopulmonary rotation.(10) Aortopulmonary rotation can be pred icted from differences in the pattern of the aortic sinus of Valsalva (SV). (11) To evaluate the influence of aortopulmonary rotation on the anomalous CA pattern in TF, and its implications for preoperative diagnosis, the stud y described below was undertaken.