Congenital Anomalous Origin of the Coronary Artery in Children: Use of Computed Tomography Coronary Angiography for Diagnosis

Abstract

Background AOCA can cause different degrees of myocardial ischemia. The various clinical presentations and diagnostic limitations of TTE often lead to missed diagnosis or misdiagnosis. Methods The retrospective study analysed the clinical date of 208 children with AOCA diagnosed by CT coronary angiography (CTCA), aimed to describe the clinical features and prognosis of the disease. Results One hundred and fifty-seven (75.5%) cases had cardiac symptoms, 3 (1.4%) had atypical symptoms, and 48 (23.1%) were asymptomatic. Levels of serological markers of myocardial injury were elevated in 49 patients (23.6%), and ST-T changes were predominant in electrocardiographic abnormalities (n = 140, 67.3%). Transthoracic echocardiography (TTE) identified 27 cases (13%) with cardiac enlargement and 10 (4.8%) with left ventricular systolic dysfunction. Only 6 cases (5.8%) of AOCA were identified by TTE, 4 of which were anomalous origin of the right coronary artery from the opposite sinus of Valsalva (R-ACAOS). The anomalous origin of the left coronary artery was the most common anomaly revealed (n = 126, 60.6%) by CTCA, followed by the anomalous origin of the right coronary artery (n = 50, 24.0%). Bilateral coronary arteries of anomalous origin were the least frequent (n = 32, 15.4%). Except for four cases who underwent surgical treatment, the others were treated conservatively. No deaths in the whole process. Conclusions CTCA has high diagnostic accuracy and can be used to determine the location and course of coronary ostia. The treatment of AOCA should be individualized according to the type of coronary origin, and surgical repair should be performed if necessary. Trial registration retrospectively registered.