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Detection of anomalous aortic origin of a coronary artery (AAOCA) by echocardiogram: When does computed tomographic
Rida Salman1, Snehal R More2, Marcos P Ferreira Botelho1
1Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX 77030, United States.
Insights
Coronary artery anomalies in children are better diagnosed with computed tomography coronary angiography (CTCA) than transthoracic echocardiography (TTE). CTCA provides crucial details when TTE is inconclusive or suggests anomalies.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Congenital Heart Disease
Background:
- Limited comparative literature exists for echocardiography (TTE) and computed tomography coronary angiography (CTCA) in pediatric suspected anomalous aortic origin of the coronary artery (AAOCA).
- Understanding the distribution of coronary anomalies and the role of advanced imaging is crucial for clinical decision-making.
Purpose of the Study:
- To compare TTE and CTCA in diagnosing AAOCA in children.
- To determine the distribution of coronary anomalies using both imaging modalities.
- To define the added value of advanced imaging in clinical decision-making for pediatric AAOCA.
Main Methods:
- Retrospective review of 100 pediatric patients (0-18 years) with suspected AAOCA who underwent both TTE and CTCA.
- Analysis of patient demographics, TTE findings, CTCA findings, and subsequent interventions.
Main Results:
- CTCA detected 94 anomalous coronaries in 93 patients, while TTE reported definitive abnormalities in 77 patients.
- CTCA offered superior characterization of ostial details, coronary artery course, and myocardial bridge detection compared to TTE.
- In cases with unclear TTE findings or suspected anomalies, CTCA provided definitive diagnoses, including hypoplastic right coronary artery with a left dominant system.
Conclusions:
- CTCA significantly enhances the diagnosis of AAOCA, particularly when coronary origins are poorly visualized or suspected on TTE.
- CTCA provides superior detail for characterizing anomalous coronary arteries, aiding in comprehensive diagnosis and management planning.
Background And Objective:
There is limited literature comparing TTE and CCTA in children with suspected AAOCA. To determine the distribution of various coronary anomalies comparing TTE and CCTA data, and define the added value advanced imaging brings in clinical decision-making.
Materials And Methods:
Retrospective review of data was obtained in patients aged 0-18 years who underwent TTE and CCTA for suspected AAOCA. Patient demographics, CCTA and TTE findings, and interventions performed were recorded.
Results:
100 consecutive patients were included (60% male), mean age 11 years (7 days-18 years old). In 93 patients, CCTA detected 94 anomalous coronaries. Definitive coronary abnormality was reported on TTE in 77 patients; 76 of which were confirmed by CCTA, 1 patient was found to have a normal variant. Suspected anomalous origin was reported in 16 patients on TTE, 13 of which were abnormal on CCTA. The coronary origin was not seen on TTE in 6 patients; of these, 3 had AAOCA on CCTA and 3 had hypoplastic RCA with left dominant system. Only 1 patient who had a normal TTE was found to have AAOCA on CCTA. CCTA was better than TTE in defining ostial characteristics and the course of the anomalous coronary artery, and detecting myocardial bridge.
Conclusions:
CCTA adds value in diagnosing AAOCA when the coronary origins are not well assessed or suspected anomalous origin is suggested on TTE. In addition, when a confident definitive diagnosis of AAOCA is reported on TTE, CCTA demonstrates better performance in determining additional features of AAOCA.
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Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...