Meyer J, Chiariello L, Hallman G L, Cooley D A
J Thorac Cardiovasc Surg. 1975 Mar;69(3):373-6.
A left anterior descending coronary artery arising from the right coronary artery can be easily injured during performance of a right ventriculotomy for correction of tetralogy of Fallot. This occurred in 2 of the 23 patients in this series, and both patients died from myocardial failure in the early period after operation. Of 19 patients who presented a combination of tetralogy of Fallot and unusual coronary artery distribution, injury to the abnormal coronary artery was avoided by a transverse right ventriculotomy either alone or combined with an upper vertical incision in 17 patients. In 2 patients a Dacron tube graft was inserted between the right ventricular outflow tract and the pulmonary artery. In 2 patients a right ventriculotomy was avoided by closing the ventricular septal defect through a transaortic approach. All 21 patients survived. Before a vertical or longitudinal incision in the right ventricular outflow tract is performed, the coronary artery distribution should always be checked and confirmation made of the normal origin of the left anterior descending branch from the left coronary artery to the left of the pulmonary artery.
起源于右冠状动脉的左前降支冠状动脉在法洛四联症矫正术的右心室切开术中容易受到损伤。本系列23例患者中有2例发生这种情况，且这2例患者均在术后早期死于心肌衰竭。在19例表现为法洛四联症合并异常冠状动脉分布的患者中，17例通过单独的横向右心室切开术或联合上部垂直切口避免了对异常冠状动脉的损伤。2例患者在右心室流出道与肺动脉之间插入了涤纶人工血管。2例患者通过经主动脉途径关闭室间隔缺损避免了右心室切开术。所有21例患者均存活。在右心室流出道进行垂直或纵向切口之前，应始终检查冠状动脉分布，并确认左前降支从左冠状动脉正常起源于肺动脉左侧。
