These ancient images come from a time when we were discovering some of the subtleties of tetralogy of Fallot. Coronary anomalies for a start. Typically, an anomalous artery would pass around the anterior face of the right ventricular outflow tract, either a LAD from the proximal right, or the RCA coming from the left. It would be in peril from the surgeon's incision into the RVOT. Though the surgeons could look out for them at the operation, it was good to be forewarned. Today, echo can detect the vessel anteriorly, but MR is lacking resolution in the infant and CT is radiation based, so there is still a place for angiography. The first image below is of a RCA arising from the LAD in a case without tetralogy, to make the point that the anomalous vessel has to make a very obvious swing around the high RVOT.
Now, in tetralogy, the RVOT is small, and this rounded course may not be present, as in the image below which is also a RCA coming from the LAD. It is not at all easy to say that it is anterior to the RVOT, but that was the case at surgery (note the sternotomy).
Actually, these vessels usually run anterior to the RVOT, in fact I think I have only seen one case where the anomalous vessel went between the great vessels. It is the next image. Note the the anomalous LAD (arrowed) coming from the RCA is closely applied to the anterior face of the aorta all the way.
And I will throw in an unusual finding in the pulmonary arteries in tetralogy. I have emphasised elsewhere that tetralogy of Fallot is the result of hypoplasia of the RVOT and of the proximal sixth aortic arches, which can lead to diffuse narrowing of the central pulmonary arteries. However, as the case below shows, there can be focal stenosis of the vessels: here a severe stenosis of the origin of the left pulmonary artery is arrowed, against a background of relatively little hypoplasia elsewhere in the central vessels.
