Circulation, Vol 88, 2532-2540, Copyright © 1993 by American Heart Association
F Fernandes, M Alam, S Smith and F Khaja
BACKGROUND. The study objective was to evaluate the role of transesophageal
echocardiography in identifying the origin of anomalous coronary arteries
and confirming their course in relation to the great vessels. The diagnosis
of coronary anomalies is made by angiography. The anomalous left main
artery with a course between the pulmonary artery and the aorta has been
associated with myocardial infarction and sudden death. The course of these
anomalous coronary arteries is difficult to demonstrate by angiography
alone. METHODS AND RESULTS. Nine patients with angiographically confirmed
anomalous coronary arteries were studied by transesophageal
echocardiography with color flow Doppler. The abnormal origin of the
anomalous coronary arteries was confirmed by transesophageal
echocardiography in all nine patients. In four patients, the left main
coronary artery originated from the right sinus of Valsalva. In all of
these patients, transesophageal echocardiography demonstrated the course of
the anomalous left main coronary artery between the aorta and pulmonary
artery better than angiography. Other anomalies that were visualized
included two patients with origin of the right coronary arteries from the
left aortic sinus, one patient with origin of the left anterior descending
from the right sinus, one patient with origin of circumflex from the right
sinus, and one patient with origin of the left main coronary artery from
the pulmonary artery. CONCLUSIONS. Transesophageal echocardiography is a
useful noninvasive test for diagnosing anomalous origin of the coronary
arteries. Furthermore, it is a valuable adjunct to angiography in
demonstrating the abnormal course of the left main coronary artery
interposed between the aorta and the pulmonary artery, a potentially
life-threatening entity.
ARTICLES
The role of transesophageal echocardiography in identifying anomalous coronary arteries
Henry Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, Mich. 48202.
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