Abstract 18549: Cardiac MR and CT Virtual Angioscopy Demonstrate Normal Coronary Ostial Morphology in Children With Anomalous Left Coronary Artery With Intraseptal Course
Background: Anomalous left coronary artery from the right sinus of Valsalva (ALCA) with intraseptal course is generally considered benign but is often confused on imaging studies with the potentially lethal interarterial, intramural ALCA with associated slit-like orifice. The clinical significance differs between the two subtypes and it is important to differentiate them in order to avoid unnecessary surgical exploration. Limited data exist on intraseptal ALCA in the pediatric population.
Methods: Medical records were retrospectively reviewed on fifteen pediatric patients diagnosed with ALCA between 11/2009 and 3/2013. We also evaluated their coronary artery origins and courses using cardiac magnetic resonance or computed tomography imaging on each patient and virtual angioscopy for three-dimensional assessment of coronary ostial morphology.
Results: Patients were 5-18 years at diagnosis; seven (67%) were male. The right and left coronary origins arose from the right sinus of Valsalva as a common origin (N=9) or as a single coronary artery (N=6). Thirteen had an anomalous intraseptal left main coronary; two had anomalous left anterior descending with retroaortic circumflex coronary artery. Anomalous coronary ostia were round without evidence of stenosis on all studies (Figure). Echocardiography identified the anomalous vessel but was neither able to describe the intraseptal ALCA course nor directly visualize or confirm a normal ostium in any patient.
Conclusions: Using cardiac magnetic resonance or computed tomography imaging, we demonstrate the anomalous coronary course and confirm round coronary ostia without ostial stenosis in our pediatric cohort with intraseptal ALCA. These data provide the basis for understanding the benign clinical course of intraseptal ALCA, differentiating it from the potentially lethal interarterial, intramural ALCA, and avoiding unnecessary surgical exploration.
- © 2013 by American Heart Association, Inc.