Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-26T08:10:59.064Z Has data issue: false hasContentIssue false
  • English
  • Français

Echocardiographic imaging of anomalous origin of the coronary arteries

Published online by Cambridge University Press:  01 December 2010

Meryl S. Cohen ,
René J. Herlong  and
Norman H. Silverman
Meryl S. Cohen*
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
René J. Herlong
Affiliation:
Sanger Heart and Vascular Institute, Charlotte, North Carolina, United States of America
Norman H. Silverman
Affiliation:
Lucille Packard Children’s Hospital, Stanford University School of Medicine, Palo Alto, California, United States of America
*
Correspondence to: M. S. Cohen, MD, Division of Cardiology, The Children’s Hospital of Philadelphia, 34th Street, Civic Center Bou levard, Philadelphia, Pennsylvania 19104, United States of America. Tel: 215 590 3354; Fax: 215 590 3788; E-mail: cohenm@email.chop.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

In the past, coronary arterial anomalies have been difficult to diagnose by non-invasive methods. Identification of coronary arterial origins is now a routine part of the standard paediatric echocardiogram. Anomalous origin of a coronary artery from the pulmonary trunk is an extremely important diagnosis to make. Many echocardiographic features are not directly related to the visualisation of the coronary arterial origin. Left ventricular dilation and abnormal ventricular performance are common, along with mitral regurgitation and evidence of collateralisation of the flow from the coronary artery that has an aortic origin. In some cases, the anomalous coronary artery can be seen to arise directly from the pulmonary trunk. Congenital atresia of the main stem of the left coronary artery has a similar echocardiographic presentation, except that its aortic origin is not determined. Anomalous aortic origin of the coronary artery has important implications, as the first presenting symptom can be sudden death. With meticulous attention to the origins of the coronary arteries, echocardiographic diagnosis can also be achieved. In contrast to the anomalous origin of a coronary artery from the pulmonary trunk, ventricular performance is usually normal. Whenever there is doubt as to the definition of the origin of the coronary arteries and, indeed, when there is serious clinical concern that a coronary artery has an anomalous origin, other testing, such as cine-computed tomography, magnetic resonance imaging, or cardiac catheterisation may be indicated for confirmation or to provide greater anatomic detail.

Keywords

Bland–White–Garland syndromeanomalous aortic originsudden cardiac deathcoronary artery
Type
Original Article
Information
Cardiology in the Young , Volume 20 , Issue S3: Rare and Challenging Congenital Cardiac Lesions: an Interdisciplinary Approach , December 2010 , pp. 26 - 34
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Lai, WW, Geva, T, Shirali, GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echo 2006; 19: 1446–1448.CrossRefGoogle ScholarPubMed
2.Yamanaka, O, Hobbs, RE. Coronary artery anomalies in126,595 patients undergoing coronary arteriography. Cath Cardiovasc Diagn 1990; 21: 28–40.CrossRefGoogle ScholarPubMed
3.Gittenberger–de Groot, AC, Poelmann, RE. Chapter 2. In Fetal Cardiology. Informa Healthcare USA, Inc., New York, 2009, 9–18.Google Scholar
4.Abrikossoff, A. Aneurysma des linken Herzeventrikels mit abnormer Abgangsstelle der linker Karonararterie von der Pulmonalis bei einem funfmonatichen Kinde. Virchows Arch (Pathol Anat) 1911; 203: 413–420.CrossRefGoogle Scholar
5.Hackensellner, HA. Uber akgessorische, von der Arteria pulmonalis abgehende Herzgfaesse und ihre Bedentung für das Verstaendnis der formalen Genese des Ursprunges einer oder beider Coronararterien von der Lungenschlagader. Frankf Z Path 1955; 66: 463–470.Google Scholar
6.Hutchins, GM, Kessler-Hanna, A, Moore, GW. Development of the coronary arteries in the embryonic human heart. Circulation 1988; 77: 1250–1257.CrossRefGoogle ScholarPubMed
7.Bogers, AJJC, Gittenberger-de Groot, AC, Poelmann, RE, Peault, BM, Huysmans, HA. Development of the origin of the coronary arteries, a matter of ingrowth or outgrowth. Anat Embryol 1989; 180: 437–441.CrossRefGoogle ScholarPubMed
8.Bland, EF, White, PD, Garland, J. Congenital anomalies of the coronary arteries: report of an unusual case associated with cardiac hypertrophy. Am Heart J 1933; 8: 787–801.Google Scholar
9.Keith, JD. The anomalous origin of the left coronary artery from the pulmonary artery. Br Heart J 1959; 21: 149–161.CrossRefGoogle ScholarPubMed
10.Schmidt, KG, Cooper, MJ, Silverman, NH, Stanger, P. Pulmonary artery origin of the left coronary artery: diagnosis by two-dimensional echocardiography, pulsed Doppler ultrasound and color flow mapping. J Am Coll Cardiol 1988; 11: 396–402.Google Scholar
11.Bunton, R, Jonas, RA, Lang, P, Rein, AJ, Castaneda, AR. Anomalous origin of left coronary artery from pulmonary artery. Ligation versus establishment of a two coronary artery system. J Thorac Cardiovasc Surg 1987; 93: 103–108.CrossRefGoogle ScholarPubMed
12.Musiani, A, Cernigliaro, C, Sansa, M, Maselli, D, De Gasperis, C. Left main coronary artery atresia: literature review and therapeutical considerations. Eur J Cardiothorac Surg 1997; 11: 505–514.CrossRefGoogle ScholarPubMed
13.Roberts, WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J 1986; 111: 941–963.Google Scholar
14.Cheitlin, MD, De Castro, CM, McAllister, HA. Sudden death as a complication of anomalous left coronary origin from the anterior sinus of Valsalva, A not-so-minor congenital anomaly. Circulation 1974; 50: 780–787.CrossRefGoogle ScholarPubMed
15.Davia, JE, Green, DC, Cheitlin, MD, et al. Anomalous left coronary artery origin from the right coronary sinus. Am Heart J 1984; 108: 165–166.CrossRefGoogle ScholarPubMed
16.Barth, CW 3rd, Roberts, WC. Left main coronary artery originating from the right sinus of Valsalva and coursing between the aorta and pulmonary trunk. J Am Coll Cardiol 1986; 7: 366–373.CrossRefGoogle ScholarPubMed
17.Chu, E, Cheitlin, MD. Diagnostic considerations in patients with suspected coronary artery anomalies. Am Heart J 1993; 126: 1427–1438.CrossRefGoogle ScholarPubMed
18.Bunce, NH, Lorenz, CH, Keegan, J, et al. Coronary artery anomalies: assessment with free-breathing three-dimensional coronary MR angiography. Radiology 2003; 227: 201–208.Google Scholar
19.Deibler, AR, Kuzo, RS, Vohringer, M, et al. Imaging of congenital coronary anomalies with multislice computed tomography. Mayo Clin Proc 2004; 79: 1017–1023.CrossRefGoogle ScholarPubMed
20.Brandt, B 3rd, Martins, JB, Marcus, ML. Anomalous origin of the right coronary artery from the left sinus of Valsalva. N Engl J Med 1983; 309: 596–598.Google Scholar
21.Taylor, AJ, Rogan, KM, Virmani, R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol 1992; 20: 640–647.Google Scholar
22.Frommelt, PC, Frommelt, MA, Tweddell, JS, Jaquiss, RD. Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an inter-arterial course. J Am Coll Cardiol 2003; 42: 148–154.CrossRefGoogle Scholar
23.Gulati, R, Reddy, VM, Culbertson, C, et al. Surgical management of coronary artery arising from the wrong coronary sinus, using standard and novel approaches. J Thorac Cardiovasc Surg 2007; 134: 1171–1178.Google Scholar
24.Jaggers, J, Lodge, AJ. Surgical therapy for anomalous aortic origin of the coronary arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005; 8: 122–127.CrossRefGoogle Scholar