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The prevalence of coronary arterial abnormalities in pulmonary atresia with intact ventricular septum and their influence on surgical results

Published online by Cambridge University Press:  18 June 2007

A. Louise Calder ,
Charles R. Peebles  and
Christopher J. Occleshaw
A. Louise Calder*
Affiliation:
Department of Paediatric Cardiology, Green Lane Hospital, Auckland, New Zealand
Charles R. Peebles
Affiliation:
Department of Paediatric Cardiology, Green Lane Hospital, Auckland, New Zealand
Christopher J. Occleshaw
Affiliation:
Department of Paediatric Cardiology, Green Lane Hospital, Auckland, New Zealand
*
Correspondence to: Dr Louise Calder, Paediatric Cardiologist, PCCS Administration, Level 3, Zone 5, Starship Hospital, Private Bag 92 024, Auckland 1030, New Zealand. Tel: +64 9 307 4949; Fax: +64 9 631 0785; E-mail: LouiseC@adhb.govt.nz
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Abstract

Background

The relatively high mortality in patients with pulmonary atresia and intact ventricular septum may be related to the presence of significant coronary arterial anomalies. This retrospective review of cineangiocardiograms was undertaken to further elucidate the types and variety of such coronary arterial abnormalities, and to assess their effect on postoperative survival.

Material and results

Details regarding coronary arterial anatomy and abnormalities were assessed in 116 patients. We noted the site and severity of lesions, and the presence of fistulous communications from the right ventricle to the coronary arteries, assessing the proportion of left ventricular myocardium affected by coronary arterial interruptions or significant stenoses, in other words, the amount dependent on coronary circulation from the right ventricle. We also measured diameters of the tricuspid and mitral valves. Fistulas were found in 87 patients (75%), interruptions of major coronary arteries in 40 patients (34%), lack of connections between the coronary arteries and the aorta in 18 patients (16%), and single origin of a coronary artery, with the right coronary artery arising from the left, in 6 patients (5%). We found increased mortality in 47 patients (40%) who had a right ventricular-dependent coronary arterial circulation. The presence of fistulas in itself was not associated with higher mortality, but the presence of coronary arterial interruptions (p = 0.05), and a higher myocardial score (p = 0.0009), were.

Conclusion

We encountered a higher prevalence of both coronary arterial abnormalities and right ventricular-dependent circulation than previously reported. Awareness of the severity of the coronary arterial abnormalities should assist in planning treatment.

Keywords

Hypoplastic right heartcongenital heart diseasecoronary arterial fistulas
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 4 , August 2007 , pp. 387 - 396
Copyright
Copyright © Cambridge University Press 2007

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