Ajaja Mohamed Rida, Cheikh Amine, Rhazali Hicham, Bouatia Mustapha, Slaoui Anas, Abouqal Redouane, El Hassani Amine, Cheikhaoui Younes
Department of Cardiac Surgery, Cheikh Zaid Hospital, Abulcasis University, Rabat, Morocco.
Department of Pharmacy, Cheikh Zaid Hospital, Abulcasis University, Faculty of Pharmacy, Rabat, Morocco.
Pan Afr Med J. 2019 Nov 22;34:157. doi: 10.11604/pamj.2019.34.157.15424. eCollection 2019.
Tetralogy of Fallot (TOF) is one of the most common cyanogenic congenital heart defects. It represents 10% of congenital heart diseases in children. Coronary artery anomalies (CAA) have been reported in 2% to 14% of cases in patients with TOF, according to angiographic, surgical and autopsy series. Many of these anomalies are difficult to detect during surgery. The objective of this article is to study the prevalence of the coronary artery anomalies in patients with TOF as well as their surgical management in our hospital between 2007 and 2015.
A retrospective study was conducted on 90 patients with TOF aged 1 month to 10 years who were operated on in the Department of Paediatric Cardiac Surgery of Cheikh Zaid Hospital between 2007 and 2015. None of the patients had preoperative coronary angiography and all the anomalies were diagnosed during surgery. Patient clinical data were collected from patient records and from the hospital information system. The qualitative variables are expressed as mean and standard deviation and the quantitative variables are expressed as a percentage. Statistical analyses were performed using SPSS 13.0 software.
Of the 90 patients with TOF followed in the study period, 9 (10%) patients had coronary artery anomalies. We found in 3 (33%) patients an anomalous origin of the left anterior descending coronary artery (LAD) from the right coronary artery (RCA), an anomalous origin of the RCA from the left coronary trunk (LCT) in 1 (11%) patient and a large infundibular branch blocking the pulmonary infundibulum in 5 (56%) patients. All the patients underwent a complete surgical treatment (closure of the ventricular septal defect (VSD) by patch plus stenosis resection plus infundibular enlargement by patch). Eight (89%) patients progressed well in postoperative care and 1 (11%) died immediately after surgery in intensive care.
The coronary anomalies detected in patients with TOF are rare but represent a challenge for the surgical team because of the difficulty of diagnosing them pre-operatively. The management of these anomalies is mainly surgical and the technique used by our team is proved to be safe and effective.
法洛四联症（TOF）是最常见的导致青紫的先天性心脏缺陷之一。它占儿童先天性心脏病的10%。根据血管造影、手术和尸检系列研究，法洛四联症患者中2%至14%的病例存在冠状动脉异常（CAA）。其中许多异常在手术过程中难以检测到。本文的目的是研究2007年至2015年我院法洛四联症患者冠状动脉异常的患病率及其手术治疗情况。
对2007年至2015年在谢赫·扎伊德医院小儿心脏外科接受手术的90例年龄在1个月至10岁的法洛四联症患者进行回顾性研究。所有患者术前均未进行冠状动脉造影，所有异常均在手术中诊断。患者临床数据从患者病历和医院信息系统中收集。定性变量以均值和标准差表示，定量变量以百分比表示。使用SPSS 13.0软件进行统计分析。
在研究期间随访的90例法洛四联症患者中，9例（10%）存在冠状动脉异常。我们发现3例（33%）患者左前降支冠状动脉（LAD）起源于右冠状动脉（RCA）异常，1例（11%）患者右冠状动脉（RCA）起源于左冠状动脉主干（LCT）异常，5例（56%）患者有一个大的漏斗部分支阻塞肺动脉漏斗部。所有患者均接受了完整的手术治疗（用补片闭合室间隔缺损（VSD）加狭窄切除术加用补片扩大漏斗部）。8例（89%）患者术后护理进展良好，1例（11%）在重症监护室手术后立即死亡。
法洛四联症患者中检测到的冠状动脉异常很少见，但由于术前诊断困难，对手术团队来说是一个挑战。这些异常的治疗主要是手术治疗，我们团队使用的技术被证明是安全有效的。
