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Coronary echocardiography in tetralogy of Fallot: diagnostic accuracy, resource utilization and surgical implications over 13 years

Laura R. Need, MD^* , Andrew J. Powell, MD^* , Pedro del Nido, MD, PhD and Tal Geva, MD^*

^* Department of Cardiology, Children’s Hospital, Boston, Massachusetts, USA
Department of Cardiac Surgery, Children’s Hospital, Boston, Massachusetts, USA
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA

View larger version (35K): [in a new window]   Figure 1 Patterns of coronary artery anatomy in tetralogy of Fallot as seen from the parasternal short-axis view. The percentage of each pattern seen in 598 patients with all types of tetralogy of Fallot is indicated in the left lower corner. Ant = anterior; br = branch; Cx = left circumflex coronary artery; L = left; LAD = left anterior descending coronary artery; LCA = left coronary artery; Post = posterior; R = right; RCA = right coronary artery.

View larger version (72K): [in a new window]   Figure 2 Origin of the LAD from the RCA crossing the right ventricular outflow tract. (A) High parasternal short-axis view. The enlarged proximal RCA supplies the LAD. (B) Leftward angled parasternal long-axis view profiling the right ventricular outflow tract (infundibulum) free wall. The LAD is seen in cross-section approximately 7 mm below the pulmonary valve. A = anterior; AoV = aortic valve; Inf = infundibulum; L = left; LAD = left anterior descending coronary artery; MPA = main pulmonary artery; RCA = right coronary artery; R/S = right/superior.

View larger version (13K): [in a new window]   Figure 3 Graph showing an increase in coronary echocardiography and a concomitant decrease in diagnostic cardiac catheterization in 598 patients with all forms of tetralogy of Fallot examined from 1983 through 1995. Cath = diagnostic cardiac catheterization; Echo = echocardiography.

View larger version (13K): [in a new window]   Figure 4 Graph showing the percentage of patients with tetralogy of Fallot undergoing complete surgical repair based on echocardiography alone from 1983 through 1995. Throughout the study period, a higher percentage of patients with tetralogy of Fallot and pulmonary stenosis (solid line) underwent surgery based on echocardiography alone compared with patients with tetralogy of Fallot and pulmonary atresia (dashed line). PA = pulmonary atresia; PS = pulmonary stenosis; TOF = tetralogy of Fallot.