Injury to the left coronary artery during repair of tetralogy of Fallot: Successful aorta-coronary polytetrafluoroethylene graft

Inadvertent transection of an anomalous left coronary artery, which originated from the right coronary artery, occurred during repair of tetralogy of Fallot in a 2-year-old child. An aorta-coronary bypass graft was constructed with a size 4 polytetrafluoroethylene conduit. Early recatheterization showed patency of the polytetrafluoroethylene graft, but a myocardial scintiscan done 3 months after operation demonstrated reduced perfusion of the areas supplied by the left coronary system. Preoperative aortography or selective coronary angiography is mandatory to avoid this potentially lethal complication. Future surgical options are discussed.