Utility and Importance of New Echocardiographic Screening Methods in Diagnosis of Anomalous Coronary Origins in the Pediatric Population: Assessment of Quality Improvement

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• 作者：Poonam P. Thankavel ; Matthew S. Lemler ; Claudio Ramaciotti
• 关键词：Anomalous coronary ; Quality ; Echocardiogram
• 刊名：Pediatric Cardiology
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：36
• 期：1
• 页码：120-125
• 全文大小：991 KB
• 参考文献：1. Angelini P, Villason S, Chan AV, Diez JG (1992) Normal and anomalous coronary arteries in humans. In: Angeline P (ed) Coronary artery anomalies: a comprehensive approach. Lippincott Williams & Wilkins, Philadelphia, pp 27-50
  2. Basso C, Maron BJ, Corrado D, Thiene G (2000) Clinical profile of congenital coronary anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 35:1493-501 CrossRef
  3. Brothers J, Gaynor JW, Paridon S, Lorber R, Jacobs M (2009) Anomalous aortic origin of a coronary artery with an interarterial course: understanding current management strategies in children and young adults. Pediatr Cardiol 30:911-21 CrossRef
  4. Camarda J, Berger S (2012) Coronary artery abnormalities and sudden cardiac death. Pediatr Cardiol 33:434-38 CrossRef
  5. Davis JA, Cecchin F, Jones TK, Portman MA (2001) Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol 37:593-97 CrossRef
  6. Frommelt PC, Berger S, Pelech AN, Bergstrom S, Williamson JG (2001) Prospective identification of anomalous origin of left coronary artery from the right sinus of Valsalva using transthoracic echocardiography: importance of color Doppler flow mapping. Pediatr Cardiol 22:327-32 CrossRef
  7. Frommelt PC, Sheridan DC, Berger S, Frommelt MA, Tweddell JS (2011) Ten-year experience with surgical unroofing of anomalous aortic origin of a coronary artery from the opposite sinus with an interarterial course. J Thorac Cardiovasc Surg 142:1046-051 CrossRef
  8. Hejmadi A, Sahn DJ (2003) What is the most effective method of detecting anomalous coronary origin in symptomatic patients? J Am Coll Cardiol 42:155-57 CrossRef
  9. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO (2009) Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-006. Circulation 119:1085-092 CrossRef
  10. Penalver JM, Mosca RS, Weitz D, Phoon CK (2012) Anomalous aortic origin of coronary arteries from the opposite sinus: a critical appraisal of risk. BMC Cardiovasc Disord 12:83 CrossRef
  11. Poynter JA, Williams WW, McIntyre S, Brothers JA, Jacobs ML, Congenital heart Surgeons Society AAOCA Working Group (2014) Anomalous aortic origin of a coronary artery: a report from the congenital heart surgeons society registry. World J Pediatr Congenit Heart Surg 5:22-0 CrossRef
  12. Thankavel PP, Brown PS, Carron HD, Ramaciotti C (2012) Imaging the coronary artery: is it really normal? How to avoid common echocardiographic pitfalls. Circ Cardiovasc Imaging 5:415-18 CrossRef
  13. Thankavel PP, Balakrishnan PL, Lemler MS, Ramaciotti C (2013) Anomalous left main coronary artery origin from the right sinus of Valsalva; a novel echocardiographic screening method. Pediatr Cardiol 34:842-46 CrossRef
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  Cardiac Surgery
  Vascular Surgery
  
• 出版者：Springer New York
• ISSN：1432-1971

文摘

Anomalous aortic origin of coronaries from the contralateral sinus (AAOCA) is rare but an important cause of cardiac death in the otherwise healthy young athlete. This necessitates prompt, accurate identification; transthoracic echocardiography (TTE) remains the primary screening tool. Assessment of accuracy is difficult since the true prevalence of the disease is unknown, with estimates at 0.3-.07?%. The incidence by TTE remains much lower, between 0.09 and 0.17?% even with sophisticated equipment and a high index of suspicion. Our goal was to incorporate two new screening views to our standard TTE protocol and assess improvement in diagnosis of AAOCA by TTE in our laboratory. Recently (2011), we incorporated two new screening methods to standard protocol. The parasternal short axis sweep is extended to visualize the anomalous segment arising superiorly from the ascending aorta before exiting the root at a site close to a ‘normal-origin. Secondly, the anomalous, interarterial coronary demonstrates an anterior, steep-angled course visualized in the parasternal long axis between the aorta and pulmonary artery. The echocardiogram database was searched for patients newly diagnosed with AAOCA in 2010 (prior to incorporation of new methods) and 2012. AAOCA incidence in our patient population improved from 0.02?% (2010) to 0.22?% (2012), age range from 4?days to 17?years. Teenagers and symptomatic patients with anomalous right coronary origin (6) underwent additional confirmatory imaging, and three underwent surgery. One patient with anomalous left coronary origin underwent surgical repair. Addition of the screening views can significantly increase the sensitivity of TTE in diagnosing AAOCA in the asymptomatic patients. We propose that these views be incorporated into the standard TTE evaluation of coronary arteries.