The anomalous origin and course of coronaries in Tetralogy of Fallot (TOF)

Background: the cyanotic heart disease tetralogy (tof) is one of the common congenital heart disease in children. the catheterization of such patients still considered as important diagnostic step before surgical correction. the prevalence of abnormal coronaries in tetralogy (tof) has been reported up to 9% in different studies. coronary abnormalities are usually difficult to delineate intraoperatively because of thick epicardial fat layer and adhesions particularly after bt shunt. aim: to find out coronary abnormalities in tetralogy of fallot (tof) children seen in our cardiac unit. place and duration of study: the study was conducted in the children hospital & institute of child health,lahore,pakistan from january 2006 to december 2014. methods: a retrospective descriptive study was done .records of all patients with tetralogy of fallot from 9 months to 16 years whose cardiac catheterization was done before going to surgical repair in our unit were selected in this study. two non-selective aortic root angiogram were done i.e.,standard 45 left anterior oblique (lao) and 20 cranial and 30 right anterior oblique (rao) views were taken to look for coronaries course. data was analyzed in ssps-19. results: total 662 patients with tetralogy underwent cardiac catheterization were included in the study. 65.4% were male while 34.6% were female. the mean age was 69±43.14 months. 94.4% of patients with tetralogy had a normal coronary anatomy while 5.6% of patients with tetralogy had abnormal coronary course. out of these patients with abnormal coronary,the most common was detected single origin of coronary artery that is 2.9% of cases. out of which 12 patients had common origin from left sided sinus i.e.,1.8% and 7 patients had common origin from right sided sinus i.e.,1.1%. 2.6% of patients with abnormal coronary had coanal branch crossing right ventricular outflow track (rvot) anteriorly and 0.2% of patients with abnormal coronaries had coanal branch crossing rvot posteriorly. conclusion: coronary artery anomalies and its course in tetralogy patients were detected upto 5.6% of the cases. single origin coronary artery abnormality was found to be the most common abnormality in this study.