|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2001; 37:593-597 © 2001 by the American College of Cardiology Foundation |
a Department of Cardiology, Children’s Hospital and Regional Medical Center, Seattle, Washington, USA
Manuscript received May 11, 2000; revised manuscript received August 1, 2000, accepted October 12, 2000.
Reprint requests and correspondence: Dr. Michael A. Portman, Department of Cardiology, Children’s Hospital and Regional Medical Center, Cardiology/CH11, 4800 Sand Point Way NE, Seattle, Washington 98105
mportm{at}chmc.org
OBJECTIVES
We sought to prospectively determine the incidence and clinical significance of major coronary artery anomalies in asymptomatic children using transthoracic two-dimensional echocardiography.
BACKGROUND
Anomalous origins of the left main coronary artery (ALMCA) from the right sinus of Valsalva or anomalous origins the right coronary artery (ARCA) from the left sinus are rarely diagnosed in children and can cause sudden death, especially in young athletes. Because most patients are asymptomatic, the diagnosis is often made post mortem. No study to date has prospectively identified anomalous coronary arteries in asymptomatic children in the general population.
METHODS
After serendipitously identifying an index case with ALMCA, we examined proximal coronary artery anatomy in children with otherwise anatomically normal hearts who were referred for echocardiography. In those diagnosed with ALMCA or ARCA, we performed further tests.
RESULTS
Within a three-year period, echocardiograms were obtained in 2,388 children and adolescents. Four children (0.17%) were identified with anomalous origin of their coronary arteries, and angiograms, exercise perfusion studies and/or stress tests were then performed. One ARCA patient had decreased perfusion in the right coronary artery (RCA) perfusion area and showed ventricular ectopy on electrocardiogram (ECG) at rest that diminished but did not resolve with exercise. A second patient with ALMCA had atrial tachycardia immediately after exercise, with inferior and lateral ischemic changes on ECG and frequent junctional and/or ventricular premature complexes both at rest and recovery.
CONCLUSIONS
This study demonstrates that although anomalous origins of coronary arteries are rare in asymptomatic children, the prevalence is greater than that found in other prospective studies. Ischemia can occur with both ALMCA and ARCA even though patients remain asymptomatic. Because of the high risk of sudden cardiac death, aggressive surgical management and close follow-up are necessary.
| ||||||||||||||||||||||
Related Article
J. Am. Coll. Cardiol. 2001 37: 598-600.
This article has been cited by other articles:
|
|
 |
|
  J. A. Brothers, P. Stephens, J. W. Gaynor, R. Lorber, L. A. Vricella, and S. M. Paridon Anomalous Aortic Origin of a Coronary Artery With an Interarterial Course: Should Family Screening Be Routine? J. Am. Coll. Cardiol., May 27, 2008; 51(21): 2062 - 2064. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Cheitlin Finding Asymptomatic People With a Coronary Artery Arising From the Wrong Sinus of Valsalva: Consequences Arising From Knowing the Anomaly to Be Familial J. Am. Coll. Cardiol., May 27, 2008; 51(21): 2065 - 2067. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Brothers, M. G. McBride, M. A. Seliem, B. S. Marino, R. S. Tomlinson, M. H. Pampaloni, J. W. Gaynor, T. L. Spray, and S. M. Paridon Evaluation of Myocardial Ischemia After Surgical Repair of Anomalous Aortic Origin of a Coronary Artery in a Series of Pediatric Patients J. Am. Coll. Cardiol., November 20, 2007; 50(21): 2078 - 2082. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Gulati, V. M. Reddy, C. Culbertson, G. Helton, S. Suleman, O. Reinhartz, N. Silverman, and F. L. Hanley Surgical management of coronary artery arising from the wrong coronary sinus, using standard and novel approaches. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1171 - 1178. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Alphonso, P. V. Anagnostopoulos, L. Nolke, A. Moon-Grady, A. Azakie, G. W. Raff, and T. R. Karl Anomalous Coronary Artery From the Wrong Sinus of Valsalva: A Physiologic Repair Strategy Ann. Thorac. Surg., April 1, 2007; 83(4): 1472 - 1476. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Angelini Coronary Artery Anomalies: An Entity in Search of an Identity Circulation, March 13, 2007; 115(10): 1296 - 1305. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kumpf, L. Sieverding, M. Gass, R. Kaulitz, G. Ziemer, and M. Hofbeck Anomalous origin of left coronary artery in young athletes with syncope. BMJ, May 13, 2006; 332(7550): 1139 - 1141. [Full Text] [PDF]
|
|
|
|
 |
|
 N E Manghat, G J Morgan-Hughes, A J Marshall, and C A Roobottom Multidetector row computed tomography: imaging congenital coronary artery anomalies in adults Heart, December 1, 2005; 91(12): 1515 - 1522. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. P. Graham Jr, D. J. Driscoll, W. M. Gersony, J. W. Newburger, A. Rocchini, and J. A. Towbin Task Force 2: Congenital heart disease J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1326 - 1333. [Full Text] [PDF]
|
|
|
|
 |
|
 R. E. Eckart, S. L. Scoville, C. L. Campbell, E. A. Shry, K. C. Stajduhar, R. N. Potter, L. A. Pearse, and R. Virmani Sudden Death in Young Adults: A 25-Year Review of Autopsies in Military Recruits Ann Intern Med, December 7, 2004; 141(11): 829 - 834. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Maron Sudden Death in Young Athletes N. Engl. J. Med., September 11, 2003; 349(11): 1064 - 1075. [Full Text] [PDF]
|
|
|
|
|
|
R. L. Romp, J. R. Herlong, C. K. Landolfo, S. P. Sanders, C. E. Miller, R. M. Ungerleider, and J. Jaggers Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery Ann. Thorac. Surg., August 1, 2003; 76(2): 589 - 596. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Giorgi, S. Dymarkowski, F. E. Rademakers, F. Lebrun, and J. Bogaert Single Coronary Artery as Cause of Acute Myocardial Infarction in a 12-Year-Old Girl: A Comprehensive Approach with MR Imaging Am. J. Roentgenol., December 1, 2002; 179(6): 1535 - 1537. [Full Text] [PDF]
|
|
|
|
|
|
P. Angelini, J. A. Velasco, and S. Flamm Coronary Anomalies: Incidence, Pathophysiology, and Clinical Relevance Circulation, May 21, 2002; 105(20): 2449 - 2454. [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Misawa, T. Saito, S.-i. Oki, and K. Fuse Management of anomalous right coronary arteries encountered during aortic valve surgery Eur. J. Cardiothorac. Surg., January 1, 2002; 21(1): 102 - 104. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Rodefeld, C. B. Culbertson, H. M. Rosenfeld, F. L. Hanley, and L. D. Thompson Pulmonary artery translocation: a surgical option for complex anomalous coronary artery anatomy Ann. Thorac. Surg., December 1, 2001; 72(6): 2150 - 2152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. M. Morphet Congenital coronary artery anomalies: diagnosable, premortem? J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1587 - 1588. [Full Text] [PDF]
|
|
|
|
|
|
C. K. L. Phoon Management of anomalous coronary artery J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1269 - 1270. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Portman, F. Cecchin, T. K. Jones, J. A. Davis, and F. M. Lupinetti Reply J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1270 - 1271. [Full Text] [PDF]
|
|
|
|
|
|
A. Davidson and T. R. Karl Major coronary artery anomalies in the pediatric population J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1270 - 1270. [Full Text] [PDF]
|
|
|
|
|
|
A. Pelliccia Congenital coronary artery anomalies in young patients: New perspectives for timely identification J. Am. Coll. Cardiol., February 1, 2001; 37(2): 598 - 600. [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
