Advertisement






Click here for more guidelines.
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2001; 37:593-597
© 2001 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Davis, J. A.
Right arrow Articles by Portman, M. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Davis, J. A.
Right arrow Articles by Portman, M. A.
Related Collections
Right arrowRelated Article

CLINICAL STUDY: PEDIATRIC CARDIOLOGY

Major coronary artery anomalies in a pediatric population: incidence and clinical importance

Julie A. Davis, MDa, Frank Cecchin, MD, FACCa, Thomas K. Jones, MD, FACCa and Michael A. Portman, MD, FACCa

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.

Abbreviations and Acronyms
  ALMCA = anomalous origin of left main coronary artery
  AOCA = anomalous origin of a coronary artery
  ARCA = anomalous origin of right coronary artery
  CABG = coronary artery bypass graft
  ECG = electrocardiogram
  LAD = left anterior descending artery
  LCA = left circumflex artery
  LMCA = left main coronary artery
  RCA = right coronary artery
  TTE = transthoracic two-dimensional echocardiography


Related Article

Congenital coronary artery anomalies in young patients: New perspectives for timely identification
Antonio Pelliccia
J. Am. Coll. Cardiol. 2001 37: 598-600. [Full Text] [PDF]



This article has been cited by other articles:


Home page
Ann. Thorac. Surg.Home page
J. E. Davies, H. M. Burkhart, J. A. Dearani, R. M. Suri, S. D. Phillips, C. A. Warnes, T. M. Sundt III, and H. V. Schaff
Surgical management of anomalous aortic origin of a coronary artery.
Ann. Thorac. Surg., September 1, 2009; 88(3): 844 - 847.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol., December 2, 2008; 52(23): e143 - e263.
[Full Text] [PDF]


Home page
CirculationHome page
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation, December 2, 2008; 118(23): e714 - e833.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
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]


Home page
J Am Coll CardiolHome page
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]


Home page
J Am Coll CardiolHome page
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]


Home page
J. Thorac. Cardiovasc. Surg.Home page
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]


Home page
Ann. Thorac. Surg.Home page
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]


Home page
CirculationHome page
P. Angelini
Coronary Artery Anomalies: An Entity in Search of an Identity
Circulation, March 13, 2007; 115(10): 1296 - 1305.
[Abstract] [Full Text] [PDF]


Home page
BMJHome page
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]


Home page
HeartHome page
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]


Home page
J Am Coll CardiolHome page
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]


Home page
ANN INTERN MEDHome page
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]


Home page
Mayo Clin Proc.Home page
A. R. Deibler, R. S. Kuzo, M. Vohringer, E. E. Page, R. E. Safford, J. N. Patton, G. E. Lane, R. L. Morin, and T. C. Gerber
Imaging of Congenital Coronary Anomalies With Multislice Computed Tomography
Mayo Clin. Proc., August 1, 2004; 79(8): 1017 - 1023.
[Abstract] [PDF]


Home page
NEJMHome page
B. J. Maron
Sudden Death in Young Athletes
N. Engl. J. Med., September 11, 2003; 349(11): 1064 - 1075.
[Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
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]


Home page
Am. J. Roentgenol.Home page
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]


Home page
CirculationHome page
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]


Home page
Eur. J. Cardiothorac. Surg.Home page
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]


Home page
Ann. Thorac. Surg.Home page
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]


Home page
J Am Coll CardiolHome page
J. A. M. Morphet
Congenital coronary artery anomalies: diagnosable, premortem?
J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1587 - 1588.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
C. K. L. Phoon
Management of anomalous coronary artery
J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1269 - 1270.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
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]


Home page
J Am Coll CardiolHome page
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]


Home page
J Am Coll CardiolHome page
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]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement