Echocardiographic Diagnosis of Coronary Artery Anomalies in Children with Tetralogy of Fallot

We evaluated the ability of two-dimensional echocardiography to define coronary anomalies in 84 patients with tetralogy of Fallot (FT). Complete studies were obtained in 71 (% 84.5) patients. Coronary anatomy was determined to be normal by echocardiography in 53 patients and was confirmed in all of these patients except one by selective coronary angiography. In this patient accessory left anterior descending coronary artery (LAD) was detected. Echocardiographically, LAD from right coronary artery (RCA), circimflex artery from RCA, and a single left coronary artery orifice in one of each patient, crossing the right ventricular outlow tract were determined and confirmed by angiography. In 15 patients accessory LAD could not be distinguished from large conal branch crossing the right ventricular outflow tract by echocardiography. Accurate evaluation of coronary anatomy is possible and major coronary abnormalities crossing the right ventricular outflow tract are correctly identified in patients with tetralogy of Fallot. Selective coronary angiography before total correction should be performed in the patient with major coronary artery crossing the right ventricular outflow tract or the right and left coronary arteries and the braches of left coronary arteries could not be demonstrated by echocardiography.