Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands.
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands; Department of Anatomy & Embryology, Leiden University Medical Center, Einthovenweg 20, 2333 ZC Leiden, the Netherlands.
Int J Cardiol. 2020 May 1;306:78-85. doi: 10.1016/j.ijcard.2020.02.037. Epub 2020 Feb 17.
An anomalous coronary artery is reported in 2% to 23% of patients with tetralogy of Fallot (TOF). Knowledge of coronary anatomy prior to corrective surgery is vital to avoid damage to vessels crossing the right ventricular outflow tract (RVOT). A meta-analysis on the prevalence of anomalous coronary arteries in TOF is lacking to date. Here, an overview of coronary anomalies in TOF is provided and implications for patient management are discussed.
PubMed, Embase and Web of Science were searched. Analysis was done using Revman 5.3 (Cochrane Community, London). The primary analysis focused on the origin and proximal course of the right and left coronary arteries. In addition, the prevalence of large conus arteries and coronary arteriovenous fistulas (CAVF) was calculated.
Twenty-eight studies, encompassing 6956 patients, were included; 6% of TOF patients have an anomalous coronary artery. Hereof, 72% cross the RVOT; the majority of the remaining 28% courses behind the aorta. Six percent of patients have a large conus artery and 4% a CAVF. Other coronary anomalies include a left or right coronary artery from the pulmonary trunk or left or right pulmonary artery, coronary tree hypoplasia and anastomoses between coronary and bronchial arteries.
The prevalence of coronary anomalies in TOF is 4-6%. In patients with an anomalous coronary artery, 72% cross the RVOT. The combined risk of encountering an anomalous coronary artery or a large conus artery crossing the RVOT is 10.3%. Coronary anatomy should be defined before surgery and the surgical approach adapted accordingly.
在法洛四联症（TOF）患者中，2%至 23%的患者存在异常冠状动脉。在进行矫正手术之前，了解冠状动脉解剖结构至关重要，这可以避免损伤穿过右心室流出道（RVOT）的血管。目前，关于 TOF 中异常冠状动脉的患病率尚无荟萃分析。本文提供了 TOF 中冠状动脉异常的概述，并讨论了其对患者管理的影响。
检索了 PubMed、Embase 和 Web of Science。使用 Revman 5.3（Cochrane 社区，伦敦）进行分析。主要分析集中在右冠状动脉和左冠状动脉的起源和近端行程上。此外，还计算了大圆锥动脉和冠状动脉动静脉瘘（CAVF）的患病率。
共纳入 28 项研究，涵盖 6956 例患者；6%的 TOF 患者存在异常冠状动脉。其中，72%的冠状动脉穿过 RVOT；其余 28%的冠状动脉大部分位于主动脉后面。6%的患者存在大圆锥动脉，4%的患者存在 CAVF。其他冠状动脉异常包括左或右冠状动脉发自肺动脉干或左或右肺动脉、冠状动脉发育不良和冠状动脉与支气管动脉之间的吻合。
TOF 中冠状动脉异常的患病率为 4-6%。在存在异常冠状动脉的患者中，72%的冠状动脉穿过 RVOT。遇到异常冠状动脉或大圆锥动脉穿过 RVOT 的联合风险为 10.3%。应在手术前确定冠状动脉解剖结构，并相应地调整手术方法。
