Identifying Abnormal Ostial Morphology in Anomalous Aortic Origin of a Coronary Artery
Matthew A Harris1, Kevin K Whitehead2, David C Shin2
1Department of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Insights
Virtual angioscopy effectively identifies abnormal coronary ostial morphology in patients with anomalous coronary arteries. This technique aids in diagnosing conditions linked to exercise-induced ischemia and sudden cardiac death.
Area of Science:
- Cardiovascular Imaging
- Pediatric Cardiology
- Medical Diagnostics
Background:
- Anomalous coronary artery origin from the contralateral sinus of Valsalva is linked to sudden death and exercise-induced ischemia.
- Aortic enlargement and elliptical ostia are suspected causes of these adverse events.
- Virtual angioscopy is proposed as a method to detect abnormal coronary ostial morphology.
Purpose of the Study:
- To evaluate the efficacy of virtual angioscopy in identifying abnormal coronary ostial morphology.
- To compare ostial morphology in patients with anomalous coronary arteries versus normal origins.
Main Methods:
- Retrospective analysis of 55 pediatric coronary artery magnetic resonance imaging studies (2006-2010).
- Included anomalous right (n=20), anomalous left (n=7), and normal coronary origins (n=28).
- Virtual angioscopy was used for visualization and measurement of coronary ostia; validated with a postmortem specimen.
Main Results:
- All 55 studies showed distinct aortic origins for coronary arteries.
- Anomalous ostia were consistently elliptical with a longer superior-inferior dimension (long-axis/short-axis ratio ≈ 2.5).
- Normal ostia were circular (long-axis/short-axis ratio ≈ 1.1), with significant differences (p < 0.001).
Conclusions:
- Virtual angioscopy successfully identifies abnormal ostial morphology in anomalous coronary artery patients.
- This imaging technique is crucial for diagnosing patients at risk of sudden cardiac death.
- Findings confirm the utility of virtual angioscopy in characterizing coronary artery anomalies.
Background:
Anomalous origin of a coronary artery from the contralateral sinus of Valsalva is associated with exercise-induced ischemia and sudden death. That is thought to be due to aortic enlargement in patients with an elliptical ostium. We hypothesize that virtual angioscopy can identify abnormal coronary ostial morphology in these patients.
Methods:
We retrospectively analyzed 55 consecutive pediatric coronary artery magnetic resonance imaging studies from January 2006 to January 2010 with the diagnosis of anomalous right (n = 20), or left (n = 7) coronary artery, or normal coronary origins (n = 28). One postmortem heart specimen with anomalous left coronary artery was imaged and analyzed to validate our technique. Virtual angioscopy analysis was used for visualization and measurement of the coronary ostia.
Results:
Distinct aortic origins of the right and left coronaries were seen in all 55 studies. An elliptical orifice with a longer superior-inferior dimension was seen in all anomalous ostia, in contrast to a circular ostium in all normal origins. That was quantified in anomalous ostia with a long-axis to short-axis ratio of 2.5 ± 0.5 (right) and 2.4 ± 0.5 (left) compared with 1.1 ± 0.2 (right) and 1.0 ± 0.3 (left) in controls (p < 0.001 for right and left ostia comparisons). Ostial morphology was confirmed in all 9 patients who underwent operative repair and in 1 patient at autopsy.
Conclusions:
Virtual angioscopy identifies abnormal ostial morphology in anomalous coronary artery patients, which is important for characterizing the diagnosis of patients who may be at risk for sudden death.
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