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Noninvasive methods of accurately diagnosing in children anomalous origin of the left coronary artery from the pulmonary trunk

Published online by Cambridge University Press:  13 August 2009

Kuang-Jen Chien
Affiliation:
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan Department of Pharmacy, Tajen University, Pingtung, Taiwan Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan Kaohsiung Armed Forces General Hospital
Ta-Cheng Huang
Affiliation:
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Kai-Sheng Hsieh
Affiliation:
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Chu-Chuan Lin
Affiliation:
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Ken-Pen Weng
Affiliation:
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Jun-Yen Pan
Affiliation:
Department of Cardiovascular Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Cheng-Liang Lee*
Affiliation:
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
*Corresponding
Correspondence to: Dr Cheng-Liang Lee Ph.D., Department of Pediatrics, Kaohsiung Veterans General Hospital, No.386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan. Tel: +886-7-3468203; Fax: 886-7-3599023; E-mail: CLLEEMD2@yahoo.com.tw

Abstract

Background

Anomalous origin of the left coronary artery from the pulmonary trunk is a rare congenital heart defect. Cardiac catheterization remains the standard means of diagnosis. Our purpose in this study is to emphasize the importance of assessing the electrocardiogram when making the diagnosis, in addition to taking note of transthoracic echocardiographic findings. We also analyzed the sensitivity of each parameter under investigation.

Methods and Results

Between June, 1999, and March, 2007, we studied 9 patients, 6 males and 3 females, with a mean age of 3.02 years, in whom anomalous origin of the left coronary artery from the pulmonary trunk was suspected subsequent to transthoracic echocardiographic examination. We examined their electrocardiograms, and undertook cardiac catheterization. In all patients, the transthoracic echocardiogram had shown retrograde flow into the pulmonary trunk, with the left coronary artery arising from pulmonary trunk, along with a dilated right coronary artery, or intercoronary collateral vessels. In 8 patients, the electrocardiogram showed deep Q wave in leads I and aVL, with depression of the ST segments over lead V4 through 6, or inversion of the T waves in leads I, II, and aVL. In the remaining patient, the electrocardiogram showed incomplete right bundle branch block. Later, cardiac catheterization confirmed the diagnosis in 8 patients, but the other patient was shown to have the right coronary artery arising from the pulmonary trunk.

Conclusions

By combining transthoracic echocardiography with study of the electrocardiogram, it is possible to provide accurate evaluation of anomalous origin of the left coronary artery from the pulmonary trunk.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2009

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Noninvasive methods of accurately diagnosing in children anomalous origin of the left coronary artery from the pulmonary trunk
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