RESUMO
OBJECTIVES: The present study sought to determine the prevalence and evaluate the patterns of various anomalies of coronary arteries in patients with tetralogy of Fallot (TOF) on multidetector CT angiography using a dual-source CT scanner. METHODS: We retrospectively reviewed CT angiographies of 955 pediatric patients, diagnosed with TOF between 1st January 2015 and 31st December 2019 and having an optimal evaluation of coronary arteries, with respect to the origin, course, and termination of the coronary arteries and associated cardiovascular anomalies. RESULTS: Anomalies of coronary arteries were observed in 8.27% (79/955) patients with TOF. Origin of accessory/proper left anterior descending (LAD) artery from right coronary artery (RCA) or right coronary sinus was the most common anomalous pattern, seen in 3.14% (30/955) patients, followed by the presence of hypertrophied conal artery seen in 2.62% (25/955) patients. The anomalous coronary artery was crossing the right ventricular outflow tract (RVOT) in all cases where the LAD artery was arising from RCA or right coronary sinus or where RCA was arising from the LAD artery. Coronary arterial anomalies were seen in a significantly higher proportion of patients with an atrial septal defect compared to those without (7/25 [28%] vs. 72/930 [7.74%]; p = .0003). CONCLUSION: The prevalence of anomalies of coronary arteries increases significantly in the presence of TOF as compared to the general population. Majority of these anomalous coronary arteries course anterior to the RVOT which can potentially pose technical difficulties with a risk of adverse surgical outcomes and increased morbidity and mortality, rendering their diagnosis crucial before surgery.
Assuntos
Anomalias dos Vasos Coronários , Tetralogia de Fallot , Criança , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/epidemiologia , Humanos , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/cirurgiaRESUMO
We present a case of an infant with tetralogy of Fallot with pulmonary atresia with an incidentally detected cervical origin of right subclavian artery. We highlight the importance of identifying this rare variation and the potential complications that may ensue.
Assuntos
Pescoço/irrigação sanguínea , Atresia Pulmonar/diagnóstico por imagem , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Tetralogia de Fallot/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Ecocardiografia , Humanos , Lactente , Masculino , Artéria Pulmonar/diagnóstico por imagem , Atresia Pulmonar/cirurgia , Tetralogia de Fallot/cirurgiaRESUMO
OBJECTIVES: The present study sought to estimate the incidence and evaluate the patterns and associations of systemic venous anomalies in patients with tetralogy of Fallot on multidetector computed tomography (CT) angiography. METHODS: We retrospectively reviewed CT angiographies of 973 pediatric age group patients diagnosed with tetralogy of Fallot, performed at our institution between 1st January 2015 and 31st December 2019, for systemic venous drainage patterns. We also proposed a structured classification and reporting system on CT angiography which would simplify the characterization, classification, and communication of these anomalies. RESULTS: Variations in systemic venous drainage patterns were observed in 146 (15.01%) patients. The most commonly observed anomaly was persistence of left superior caval vein, which was seen in 112 (11.51%) patients, with the most prevalent pattern being the presence of bilateral superior caval veins with no intercommunicating vein (n = 85). The second most common anomaly observed was presence of anomalous brachiocephalic vein (39/973 [4.01%]). Patients with an anomalous course of brachiocephalic vein had significantly higher prevalence of a right aortic arch than those without (23/39 [58.97%] vs 188/934 [20.13%]; P < .0001). Similarly, a higher prevalence of pulmonary atresia was noted in patients with an anomalous course of brachiocephalic vein compared to those without (8/39 [20.51%] vs 80/934 [8.57%]; P = .0109). CONCLUSION: There is a high incidence of anomalies of superior caval veins and brachiocephalic vein in the presence of tetralogy of Fallot. With advancements in corrective cardiac surgery and use of intraoperative cardiopulmonary bypass, the presence of systemic venous anomalies assumes greater significance making preoperative identification of these anomalies imperative.
Assuntos
Tetralogia de Fallot , Angiografia , Veias Braquiocefálicas/diagnóstico por imagem , Criança , Angiografia por Tomografia Computadorizada , Humanos , Incidência , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/epidemiologia , Tetralogia de Fallot/cirurgia , Veia Cava SuperiorAssuntos
Veias Braquiocefálicas/anormalidades , Veias Braquiocefálicas/diagnóstico por imagem , Tetralogia de Fallot/diagnóstico por imagem , Veias Braquiocefálicas/embriologia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Lactente , Masculino , Tetralogia de Fallot/embriologiaAssuntos
Artéria Carótida Primitiva , Artéria Carótida Externa , Artéria Carótida Interna , Aorta Torácica , Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Externa/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Humanos , Masculino , Adulto JovemAssuntos
Defeito do Septo Aortopulmonar/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Atresia Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/diagnóstico por imagem , Tronco Arterial/diagnóstico por imagem , Defeito do Septo Aortopulmonar/fisiopatologia , Defeito do Septo Aortopulmonar/cirurgia , Diagnóstico Diferencial , Feminino , Defeitos dos Septos Cardíacos/fisiopatologia , Defeitos dos Septos Cardíacos/cirurgia , Humanos , Lactente , Valor Preditivo dos Testes , Atresia Pulmonar/fisiopatologia , Atresia Pulmonar/cirurgia , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/cirurgia , Tronco Arterial/anormalidades , Tronco Arterial/fisiopatologia , Tronco Arterial/cirurgiaAssuntos
Anormalidades Múltiplas , Ventrículos do Coração/anormalidades , Síndrome do Coração Esquerdo Hipoplásico/complicações , Síndrome de Cimitarra/complicações , Tronco Arterial/anormalidades , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Ventrículos do Coração/diagnóstico por imagem , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico por imagem , Lactente , Masculino , Flebografia , Síndrome de Cimitarra/diagnóstico por imagem , Tronco Arterial/diagnóstico por imagemRESUMO
Anomalies of origin of coronary arteries are an uncommon occurrence and found in approximately 1-2% of the general population. While a large proportion of these anomalies are clinically silent, a few might be hemodynamically significant and may even result in sudden cardiac death. Comprehensive knowledge of the normal as well as variant anatomies of the coronary artery origin and familiarity with imaging appearances and clinical significance of these anomalies is imperative for precise diagnosis and subsequent planning of treatment, whenever required. Multidetector computed tomography angiography, on account of its non-invasiveness, faster scan times and multiplanar reconstruction capabilities, is increasingly being utilized for characterization of coronary artery origin anomalies and their three-dimensional spatial relations. It shows a superior rate of detection of these anomalies compared to conventional angiography, providing more accurate delineation of the ostium as well as course. With the advent of newer generation CT scanners and use of advanced dose reduction techniques, images can be obtained rapidly having excellent spatial resolution and with minimal radiation dose. In this review article, we present the multidetector CT angiography imaging findings of the spectrum of anomalous coronary artery origin, using a third-generation dual-source CT scanner.