title: Total correction in tetralogy of Fallot with anomalous major coronary artery: an alternative method to conduit use.
abstract: BACKGROUND
  A coronary artery anomaly precludes the use of a trans-annular patch in right ventricular outflow tract (RVOT) reconstruction. Herein we present three patients with coronary artery anomalies who underwent total corrective operations without using a conduit.
  
  
  METHODS
  Between 2007 and 2010, 84 patients with tetralogy of Fallot (TOF) were operated on. Nine (9.4%) of them had a coronary artery anomaly. Three (3.1%) of the patients were operated on using the double-outflow technique and two had a Blalock-Taussig shunt before the total corrective operation. In two patients, the left anterior descending artery (LAD) and in one, the right coronary artery (RCA) crossed the RVOT.
  
  
  RESULTS
  Postoperatively, the right-to-left ventricular pressure ratios were 0.45, 0.59 and 0.60 after cardiopulmonary bypass. No gradient was detected in the RVOT in postoperative echocardiographical measurements (< 15 mmHg gradient). In all three patients, there were moderate pulmonary insufficiencies. All were discharged home on the sixth day postoperatively. Mean follow-up duration was 9.8 ± 8 months. In the follow up of all three patients, there were moderate pulmonary insufficienciencies but no right ventricular dysfunction.
  
  
  CONCLUSIONS
  The 'double-outflow' technique is appropriate for TOF patients with a major coronary artery anomaly since it can easily be performed without the need of a conduit.
authors.affiliation: Department of Cardiovascular Surgery, Baskent University Hospital, Istanbul, Turkey. bsaritas@hotmail.com
authors.forename: B
authors.initials: B
authors.lastname: Saritas
authors.forename: E
authors.initials: E
authors.lastname: Ozker
authors.forename: E
authors.initials: E
authors.lastname: Vuran
authors.forename: U
authors.initials: U
authors.lastname: Yoruker
authors.forename: C
authors.initials: C
authors.lastname: Ayabakan
authors.forename: R
authors.initials: R
authors.lastname: Turkoz
mesh_terms: D058366:Blalock-Taussig Procedure; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000601:surgery*; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020127:Recovery of Function; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000601:surgery*