Abstract 16053: Preoperative Best Diagnostic Test of Anomalous Coronaries in the Adult are Angiography and CTA
Introduction: Adults with congenital cardiac disease have surpassed children. Patients with anomalous coronary(AC) are increasingly recognized in adulthood. Workup in adults may be different that children. Multiple reports exist of adults undergoing a range of diagnostic modalities. No one has previously determined the most valuable workup for diagnosis in a contemporary series of adults with AC. We assessed the hypothesis that workup of adults with AC may be streamlined to coronary catheterization(CC) and CTA.
Methods: 27 patients(pts) with AC consisted of five anomalous left coronaries(ALM), six anomalous left circumflex coronaries(ALCx) and 16 anomalous right coronaries(ARCA). Workup included a combination of EKG, CC, exercise stress test(EST), CT angiogram(CTA), MRI or nuclear medicine test. IRB approval was previously obtained.
Results: ALM pts underwent up to five examinations from CC, to EST, EKG, CTA and echo with average number of 3.8 tests. CC was diagnostic in all 5. EST obtained in 4/5 was abnormal in all 4. Similarly EKGs obtained in 4 were all abnormal. CTA in the last two repaired were abnormal. Echo demonstrated no abnormal function in both. 6/6 ALCx were diagnosed by CC. 4/6 underwent EST and all 4/4 were abnormal.
There were 16 ARCA undergoing up to seven examinations with average of 3.8 tests. 15/16 obtained EKG; only 7 abnormal. 15/16 underwent CC; 15/15 were abnormal. One ARCA did not undergo CC, as diagnosis was made previously by CTA. CTA was obtained in 8/16; positive in 8/8. EST was obtained in 9/16; abnormal in 5/9. Echo was obtained in 9/16; only abnormal in 1/9. MRA was abnormal in 2/16. Nuclear medicine studies were obtained in 3/16 and all were abnormal.
Conclusion: In summary, EKG was twice as likely to be abnormal in ALM that ARCA. Similarly, EST was 100% abnormal in ALM and only 56% for ARCA. All nuclear medicine tests in ARCA were abnormal in those with abnormal EST. CC was abnormal in 5/5 ALM, 6/6 ALCx and 15/15 ARCA. CTA was abnormal in all ALM and ARCA when obtained. MRA in two ARCA who had not undergone CTA were abnormal. Echo never identified an AC origin and rarely demonstrated abnormal function. In conclusion, the two most helpful diagnostic tests in this large group of adults with anomalous coronaries were CC and CTA.
- © 2013 by American Heart Association, Inc.