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Surgical treatment of tetralogy of Fallot with abnormal course of the coronary artery
Surgical treatment of tetralogy of Fallot with abnormal course of the coronary artery
Mehmet Balkanay, Ercan Eren, Mehmet Erdem Toker, Adil Polat, Cüneyt Keleş, Mustafa Güler, Cevat Yakut
Department of Cardiovascular Surgery, Kartal Heart Education and Research Hospital, İstanbul
Surgically important coronary artery anomalies may be
seen uncommonly in tetralogy of Fallot. The most commonly
encountered anomaly is the abnormal origin of the
left anterior descending coronary artery from the right
coronary artery crossing the right ventricular outflow tract.
Many different techniques have been described for repair of
tetralogy of Fallot with a coronary anomaly. We performed
a single right ventriculotomy parallel and distal to the course
of the left anterior descending coronary artery that crossed
the right ventricular outflow tract in a seven-year-old boy,
alleviating the right ventricular outflow tract obstruction
without damaging the left anterior descending coronary
artery. The pulmonary annulus was enlarged with a pericardial
patch through the parallel ventriculotomy, and the
patient was discharged without any problem. Our technique
has the advantages of leaving the anomalous coronary artery
intact throughout the operation, relieving right ventricular
outflow tract obstruction easily and satisfactorily, allowing
transannular patch application without any damage to the
coronary artery, avoiding strecthing of the coronary artery
along its course through linear closure of the right ventriculotomy,
and avoiding any conduit or valve use.
Keywords : Coronary angiography; follow-up; tetralogy of Fallot/ complications/radiography/surgery
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