Tetralogía de Fallot: arteria coronaria cruzando el tracto de salida ventricular derecho. Opciones quirúrgicas

The existence of an anomalous coronary artery crossing the infundibulum of the right ventricle can make surgical repair difficult, as well as increase morbidity and operative mortality in certain pathologies in which it is necessary to treat stenosis at the level of the right ventricular outflow tract, as in the case of patients with Tetralogy of Fallot. The presence of this anomaly often requires a variation of the surgical strategy to avoid injury to the anomalous coronary artery and its fatal consequences. One surgical option is the implantation of a conduit between the right ventricle and the pulmonary artery, but this procedure has certain disadvantages. In this article we report most of the surgical techniques described in the literature, which attempt to treat this group of patients with good results, avoiding the implantation of an extracardiac conduit. In addition, we include a possible decision scheme, which may help the surgeon in the choice of the most appropriate surgical technique, depending on the anatomical characteristics of the patient.