A quantitative assessment of aorta root rotation in patients with tetralogy of Fallot evaluated by MSCT.

Lack of conal rotation and conal malseptation is a characteristic anatomical feature for TOF which lead to dextroposed position of aorta and significant RVOT narrowing. The quantitative assessment of these anatomical features using modern cardiac imaging modality has been rarely discussed in the literature. All TOF scanned had in our center from 2013 till 2019 were included. The angle of aortic root rotation was recorded by measuring the angle between a line connecting the midpoint of the non-coronary sinus to the anterior commissure and another line along the interatrial septum. Rotation angles were correlated with proximal main pulmonary artery (MPA) size indexed to BSA. 287 TOF patients were included, 258 patients (91%) had TOF with pulmonary stenosis (TOF-PS) including 138 male (54%), median age 2 years (2 months-40 years), and 29 patients (9%) had TOF with pulmonary atresia (TOF-PA) including 17 male (59%), median age 5 years (1 m-33 years). The whole cases demonstrated clockwise rotation of the aortic root. The mean rotation angle in TOF-PS group was 52.6 ± 20.9° and in TOF-PA group was 64.9 ± 13.9°. Proximal MPA diameter was 11.1 ± 5.9 mm/m2. There was a significant negative correlation between aortic root rotation angle and proximal MPA diameter (r = - 0.262, P = 0.000). The rotation angle of aortic root was significantly higher in TOF-PA compared to TOF-PS (64.9 ± 13.9° vs. 52.6 ± 20.9°, P = 0.001, respectively). MSCT provide a quantitative measurement methodology of conal malseptation and its effect in TOF patients. There is a clockwise rotation angle of the aortic root in TOF patients that correlates negatively with proximal MPA size. TOF-PA have a larger rotation angle of aortic root.

Coronary artery anomalies in tetralogy of Fallot patients evaluated by multi slice computed tomography; myocardial bridge is not a rare finding.

ABSTRACT: Based on coronary angiography and interoperative inspection, anomalous origin of coronary artery crossing the right ventricular outflow tract (RVOT) is common in tetralogy of Fallot (TOF) patients. However, other coronary anomalies may be underestimated due to the overlying myocardium, epicardial fat, or adhesions due to previous palliative surgery. Currently, coronary artery visibility dramatically improved by multislice computed tomography (MSCT). We performed this study to assess the coronary arteries anatomy in TOF patients using MSCT.All TOF patients underwent MSCT examination at our centre from 2013 till 2019 were included. Assessment of the coronary arteries' origin and course were performed. Presence of myocardial bridge were assessed, and indexed RV mass was calculated.318 TOF patients were included, median age 2 years (range 1 month-46 years), 175 males (55%). The abnormal coronary artery origin and course were detected in 20 patients (6%); coronary artery crossed RVOT in 13 patients (65%), 5 patients (25%) had a retro-aortic course and 2 patient (10%) had inter-arterial course. Myocardial bridges of left anterior descending artery or/and right coronary artery were reported in 100 patients (36%), no myocardial bridge of left circumflex was reported. RV mass was 29.0 ±â€Š21.1 g/m2. There was no correlation between RV mass and presence of myocardial bridges.MSCT is a useful imaging modality for detection of coronary arteries anomalies in TOF patients. Coronary artery crossing RVOT is not the only abnormal course and myocardial bridging is not a rare finding. Further studies are needed to demonstrate the clinical significance of these observations.