Associated Coronary and Cardiac Anomalies among One to Eighteen Years Old Tetralogy of Fallot Patients.

Abstract

Precise pre-operative diagnosis of any coronary or cardiac anomalies in Tetralogy of fallot (TOF) patients can minimize intra-operative and postoperative complications. In such cases time appropriate alternative surgical approaches may be required to consider, thus the consequent morbidity and mortality can be reduced. The study attempted to observe the TOF patients to assess the pattern of associated coronary and cardiac anomalies among them. This cross sectional study was carried out in the departments of Paediatric Cardiology in three tertiary level hospitals in Dhaka, Bangladesh, from January 2018 to December 2018. Seventy two diagnosed cases of TOF, who went for cardiac catheterization in the respective hospitals, aged between one to eighteen years (1 to 18) were recruited. Cardiac catheterization and angiography was performed via femoral route following the standard protocol. Angiographic findings of cardiac catheterization of each patient was monitored and recorded. Data analysis was carried out using SPSS software, version 22.0. Among the TOF patients, associated coronary anomalies were present in 9 patients (12.5%) and associated cardiac anomalies were present in 52 patients (72.22%). Single associated cardiac anomaly was present in 47.22% patients and multiple associated cardiac anomalies were present in 25.0%. The presentations of coronary artery anomalies were as such right coronary artery arising from non-coronary sinus or from high up posteriorly or from LAD or from left coronary sinuses in 2.78% cases each and there was 1.39% cases of single coronary ostium from non-coronary sinus. The presentation of associated cardiac anomalies showed that, major aortopulmonary collateral artery (MAPCA) was the most common associated cardiac anomalies found in 65.27% of the TOF patients in this study. Atrial septal defect and right aortic arch was found in 22.2% and 11.10% of the TOF patients respectively. Patent ductus arteriosus and persistent left superior vena cava- each was present among 4.20% of the patients. Right pulmonary artery stenosis, supravalvular pulmonary stenosis, left pulmonary artery stenosis, aorto-pulmonary window, pulmonary atresia- each was present in 1.40% of the patients. Among the cardiac anomalies, the patent ductus arteriosus and persistent left superior vena cava was statistically significantly associated with coronary anomalies in this study (p<0.05). Anomalous coronary artery and associated cardiac lesions are common among the patients with TOF in Bangladesh. Coronary artery anomalies are significantly associated with other cardiac anomalies namely PDA and persistent left superior vena cava (PLSVC). Large scale multicenter study is further required, to understand the co-existence of coronary and cardiac anomalies among TOF patients to actualize more scrutinized diagnostic and surgical outline for better treatment outcome among these patients.