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Published on: August 28, 2018
Aberrant coronary arteries: a reliable echocardiographic screening method
Saadeh B Jureidini1, Cynthia J Marino, Gautam K Singh
1Section of Cardiology, Department of Pediatrics, Saint Louis University School of Medicine/Cardinal Glennon Children's Hospital, St Louis, Missouri 63104, USA. jureidsb@slu.edu
Insights
Aberrant origin of a coronary artery (ABO CA) is dangerous, but a new echocardiographic screening sign is reliable. This sign, visible in 88% of patients, aids in early detection of ABO CA.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatric Cardiology
Background:
- Aberrant origin of a coronary artery (ABO CA) from the contralateral aortic sinus is a life-threatening condition with a high risk of sudden cardiac events.
- Current screening methods for ABO CA are unreliable, necessitating improved diagnostic approaches.
Purpose of the Study:
- To determine if a specific echocardiographic finding in the anterior aortic wall on a long-axis view can serve as a reliable screening sign for ABO CA.
Main Methods:
- Retrospective evaluation of echocardiograms from 8 patients diagnosed with ABO CA.
- Comparison with echocardiograms from 1743 age-matched control patients.
- Assessment for a specific screening sign in the anterior aortic wall on the long-axis view.
Main Results:
- The proposed echocardiographic screening sign was identified in 7 of 8 patients (88%) with ABO CA.
- The sign was not detected in ABO CA originating from the circumflex artery branch.
- The anterior aortic wall was normal in all control patients, with a very low false-positive rate (0.3%).
Conclusions:
- The identified echocardiographic sign is a reliable and easily recognizable screening tool for ABO CA.
- This screening sign should prompt further comprehensive cardiovascular assessment to confirm the diagnosis and guide management.
Background:
Aberrant origin (ABO) of a coronary artery (CA) from the contralateral aortic sinus with a subsequent interarterial course is a life-threatening condition. It carries a 28% to 55% risk for a sudden coronary event or death, but there are no reliable screening methods.
Objective:
We sought to determine whether imaging a cross section of a coronary segment in the anterior aortic wall on the long-axis view may be used as an echocardiographic screening sign for ABO CA.
Methods:
The echocardiograms of all patients with ABO CA were evaluated for the screening sign and compared with those of age-matched control patients.
Results:
Between January 1989 and October 2002, we identified 8 patients with ABO CA (median age: 15 years). Of these patients, 4 were symptomatic and 4 were discovered incidentally. The electrocardiogram produced normal findings in 5 of 8 patients, maximal stress test produced normal findings in 5 of 6 patients, and thallium perfusion test produced negative results in 2 of 3 patients. There were 4 patients with ABO in the main left CA, 3 with ABO in the right CA, and 1 with ABO in the circumflex CA branch. The screening sign was readily visible in 7 of the 8 patients (88%), and all 7 of these patients had ABO in a main CA. Only in the ABO in the circumflex CA branch was the screening sign not detected. The 1743 control patients (median age: 14 years) showed normal anterior aortic wall, which was void of any CA segment. In 5 control patients (0.3%, P <.001) the normal right CA was visible on the long-axis view, but was not confused for a false-positive screening sign.
Conclusion:
We concluded that the proposed screening sign for ABO CA is reliable and easily recognizable, and should prompt a comprehensive assessment of the CA.
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