{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T03:26:12Z","timestamp":1762917972988},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p \/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Repair of tetralogy of Fallot (ToF) can be challenging in the presence of an abnormal coronary artery (CA) in 5\u201312% of cases. The aim of this study was to report our experience with ToF repair without the systematic use of a right ventricle-to-pulmonary artery (RV-PA) conduit.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>We conducted a monocentric retrospective study from 2000 to 2016, including 943 patients with ToF who underwent biventricular repair, of whom 8% (n\u2009=\u200976) presented with an abnormal CA. Mean follow-up time was 50\u2009months (1\u2009month\u201318\u2009years).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The most frequent CA anomaly was the left descending artery arising from the right CA (n\u2009=\u200947, 61.8%). The median age at repair was 7.7\u2009months (1.8\u2009months\u201316\u2009years). Thirteen patients (17%) required prior palliation, mostly systemic pulmonary shunts for anoxic spells in the neonatal period. Surgical repair allowed us to preserve the annulus in 40 patients (53%) by combining PA trunk plasty, commissurotomy and infundibulotomy under the abnormal CA. If the annulus had to be opened (n\u2009=\u200935, 46%), a transannular patch was inserted after a vertical incision of the PA trunk and extended obliquely on the RV over the anomalous crossing CA (with an infundibulotomy under the abnormal CA). Three patients (4%) required the insertion of an RV-PA conduit (1 valved tube and 2 RV-PA GORE-TEX tubes with annulus conservation). The early mortality rate was 4% (n\u2009=\u20093); none of the deaths was coronary related. Four patients (5%) required reoperation (2 early and 2 late reoperations) for residual pulmonary stenosis, 3 of whom had annulus preservation during the initial repair. The mean RV\/left ventricle (LV) pressure ratio and an RV\/LV pressure ratio &gt;2\/3 were identified as risk factors for right ventricular outflow tract (RVOT) reinterventions (P\u2009=\u20090.0026, P\u2009=\u20090.0085, respectively), RVOT reoperations (P\u2009=\u20090.0002 for both) and reoperation for RVOT residual stenosis (P\u2009=\u20090.0002, P\u2009=\u20090.0014, respectively). Two patients underwent pulmonary valve replacement. Freedom from late reoperation was 100% at 1\u2009year, 97% at 5\u2009years and 84% at 10 and 15\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Repair of ToF and abnormal CA can be performed without an RV-PA conduit, with an acceptable low reintervention rate. The high early mortality rate in this series remains a concern. If any doubt remains about the surgical relief of the RVOT obstruction, the RV\/LV pressure ratio should always be measured in the operating room.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezz030","type":"journal-article","created":{"date-parts":[[2019,1,22]],"date-time":"2019-01-22T04:55:33Z","timestamp":1548132933000},"page":"94-100","source":"Crossref","is-referenced-by-count":12,"title":["Tetralogy of Fallot and abnormal coronary artery: use of a prosthetic conduit is outdated"],"prefix":"10.1093","volume":"56","author":[{"given":"Margaux","family":"Pontailler","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chlo\u00e9","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R\u00e9gis","family":"Gaudin","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Moreau de Bellaing","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mansour","family":"Mostefa Kara","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman","family":"Haydar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Barbanti","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damien","family":"Bonnet","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal","family":"Vouh\u00e9","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Raisky","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,2,11]]},"reference":[{"key":"2019073110402865500_ezz030-B1","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/S0022-5223(98)00454-1","article-title":"Transatrial-transpulmonary tetralogy of Fallot repair is effective in the presence of anomalous coronary arteries","volume":"116","author":"Brizard","year":"1998","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2019073110402865500_ezz030-B2","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1177\/021849230501300403","article-title":"Associated coronary anomalies in 135 Iranian patients with tetralogy of Fallot","volume":"13","author":"Hekmat","year":"2005","journal-title":"Asian Cardiovasc Thorac 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