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Ann Thorac Surg 1996;61:1879
© 1996 The Society of Thoracic Surgeons

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Correspondence

Anomalous Coronary Artery in Tetralogy

9000 W Wisconsin Ave Po Box 1997 Milwaukee Wi 53201

To the Editor:

I read with interest the article, ``Anomalous Course of the Left Main Coronary Artery in Tetralogy of Fallot,'' by Davis and associates [1]. I would like to make the following comment.

The diagnosis of an anomalous course of the left coronary artery in patients with tetralogy of Fallot is made by inspection of the lateral coronary angiogram. The normal left coronary artery arises from the posterior aortic root and is seen traversing the aortic root region from posterior to anterior. If one does not visualize this course from posterior to anterior, one should presume that an anomalous coronary is present. This is confirmed by the observation of an anterior aortic root origin of the left anterior descending coronary artery, or in this case, the left main coronary artery. Figure 1B in the article by Davis and associates clearly shows this anomalous course.

I hope my comments will augment Davis and associates' suggestions to avoid the serious complication of left coronary artery injury during the performance of a right ventriculotomy.

Reference

1. Davis JT, Testke DW, Allen HD, Cohen DM, Schauer GM. Anomalous course of the left main coronary artery in tetralogy of Fallot. Ann Thorac Surg 1996;61:229–31.[Abstract/Free Full Text]

Reply

Department of Thoracic Surgery Children's Hospital 700 Children's Dr Columbus OH 43205-2696

To the Editor:

My colleagues and I appreciate the comments of Dr Litwin and recognize his many contributions over the years to the literature in pediatric cardiac surgery and specifically with regard to tetralogy of Fallot and coronary artery anomalies. Unfortunately, it has been our experience that distinguishing the cusp of origin of the coronary arteries in tetralogy is a somewhat inexact science because of varying degrees of obliquity of the lateral projection that are currently used as well as varying degrees of rotation of the aorta within the chest. Although in retrospect an anterior origin is identified in Figure 1B, this was not apparent in prospective evaluation of multiple angiograms reviewed by pediatric cardiologists and cardiac surgeons at two large institutions. This was probably because this particular variety of coronary anomaly had not been previously appreciated in the setting of tetralogy of Fallot, and we correctly believed that these studies had ruled out the anomaly of an aberrant origin of the left anterior descending coronary artery. We share Dr Litwin's hope that this discussion will raise the index of suspicion for this particular coronary anomaly in the setting of tetralogy and, therefore, decrease the risk of coronary injury in the future.

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Litwin, S. B. Articles by Davis, J. T. Search for Related Content PubMed PubMed Citation Articles by Litwin, S. B. Articles by Davis, J. T.