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Anomalous coronary arteries: a multicenter pediatric autopsy study
J Lipsett1, S D Cohle, P J Berry
1Department of Histopathology, Flinder's Medical Centre, Bedford Park, Australia.
Pediatric Pathology
|March 1, 1994
Summary
Anomalous coronary arteries (ACAs) occur in 0.5% of pediatric autopsies. Careful examination during autopsy is crucial for identifying these potentially life-threatening congenital heart anomalies.
Area of Science:
- Pediatric Pathology
- Congenital Heart Disease
- Forensic Medicine
Background:
- Anomalous coronary arteries (ACAs) are congenital heart anomalies that can lead to myocardial ischemia, arrhythmias, angina, infarction, and sudden cardiac death.
- Understanding the prevalence and significance of ACAs in pediatric autopsy populations is essential for accurate diagnosis and risk assessment.
Purpose of the Study:
- To determine the incidence and spectrum of anomalous coronary arteries (ACAs) in a large pediatric autopsy cohort.
- To analyze the clinical significance, associated anomalies, and pathological findings in pediatric cases with ACAs.
Main Methods:
- Retrospective analysis of 7857 pediatric autopsy cases from four tertiary care centers.
- Detailed examination of coronary artery origins, courses, and associated cardiac and non-cardiac anomalies.
- Correlation of ACA types with age at death, cardiomegaly, myocardial damage, and presenting clinical features.
Main Results:
- The incidence of ACAs was 0.5%, with ectopic origin from the aorta (43%) and pulmonary trunk (40%) being most common.
- ACAs were associated with other anomalies in 57% of cases, including cardiac defects (43%) and growth retardation (50%).
- Cardiomegaly was present in 92% of cases; however, histological ischemic damage was observed in only 50%.
Conclusions:
- ACAs are significant findings in pediatric autopsies, often associated with other congenital defects and cardiomegaly.
- ACAs originating from the pulmonary trunk showed a higher association with early mortality, severe cardiomegaly, and myocardial scarring.
- Thorough examination of coronary artery anatomy, including ostial origin, course, and potential obstructions, is critical during pediatric autopsies.