Clinical analysis of 208 children with congenital coronary artery origin abnormalities / 中国小儿急救医学

Objective:To describe the clinical features and prognosis of congenital anomalous origin of coronary artery(AOCA) in children to increase our understanding of the disease.Methods:This retrospective study included children diagnosed with AOCA using computed tomography coronary angiography(CTCA) admitted to the Department of Cardiology, Beijing Children′s Hospital, Capital Medical University, from January 1, 2014 to December 31, 2019.The clinical presentations, laboratory results, imaging analyses, treatments, and prognoses of these patients were analyzed.Results:A total of 208 children, including 105 boys and 103 girls, we evaluated the ages(9.03±4.18)years old with AOCA.Of these, 157 cases(75.5%) presented with cardiac symptoms, such as chest tightness, palpitations, dizziness, syncope, fatigue, and decreased endurance.Three cases(1.4%) had atypical symptoms of paroxysmal crying, dyspnoea and cyanosis, and 48 cases(23.1%) were asymptomatic.Levels of serological markers of myocardial injury were elevated in 59 cases(28.4%), and 140 cases(67.3%) had predominant ST-T abnormalities on electrocardiograms.Transthoracic echocardiography identified 27 cases (13%) with cardiac enlargement and ten cases(4.8%) with left ventricular systolic dysfunction.There were 126 cases(60.6%) with the anomalous origin of the left coronary artery revealed by CTCA, 50 cases(24.0%) with the anomalous origin of the right coronary artery and 32 cases(15.4%) with bilateral coronary arteries of anomalous origin.Five children underwent surgical treatment, and the remaining 203 children were treated conservatively with drugs.The whole group was successfully treated, and no death case was recorded during the follow-up period.Conclusion:AOCA may cause different degrees of myocardial ischemia.Diverse clinical presentations and diagnostic limitations of transthoracic echocardiography often lead to missed diagnosis or misdiagnosis.In contrast, CTCA has high diagnostic accuracy and can be used to identify the location and course of the coronary ostia.Hence, the management of AOCA should be tailored on a case-to-case basis, taking into consideration of the specific type of coronary origin, with surgical intervention being warranted if necessary.

Clinical characteristics of anomalous origin of coronary artery accompanied with myocardial damage in children:A report of 72 cases / 中国实用儿科杂志

OBJECTIVE: To investigate the clinical characteristics and treatment strategies of anomalous origin of the cor⁃onary artery accompanied with myocardial damage,so as to improve the level of clinicians' diagnosis and treatment of this disease. METHODS: The clinical data of 72 cases of anomalous origin of the coronary artery accompanied with myo⁃cardial damage admitted in Department of Cardiology,Beijing Children's Hospital,Capital Medical University from2015 to 2017 were analyzed retrospectively. The clinical characteristics,diagnosis and treatment methods were analyzed.RESULTS: In 42 cases(58.3%),chest pain,chest tightness and palpitation were the main clinical symptoms. ECG abnor⁃malities were mainly ST-T changes(62.5%). Echocardiography showed 13 cases(18.1%)of cardiac enlargement,4 cas⁃es(5.6%)of left ventricular systolic dysfunction. Coronary artery CT angiography(CTA)showed that the anomalous ori⁃gin of the left coronary artery was the most frequent(73.6%),followed by the anomalous origin of bilateral coronary arter⁃ies(13.9%),and the anomalous origin of the right coronary artery was the least frequent(12.5%). The whole group was successfully treated with no death. CONCLUSION: There might be a correlation between the anomalous origin of coronary artery and ischemic myocardial damage. In the examination of patients,pediatricians should pay more attention to the judgments of the position and movement of the coronary artery by CTA,and attach importance to the differential diagno⁃sis between ischemic myocardial damage and myocarditis.

Acute coronary syndrome associated with anomalous origin of circumflex artery. Case report and literature review / Síndrome coronario agudo asociado al origen anómalo de la arteria circunfleja. Reporte de caso y revisión de literatura

Abstract: We present a case of an acute coronary ischemic syndrome associated with anomalous origin of the circumflex artery, with a right coronary sinus origin independent of the right coronary artery, which has a prevalence of 0.1 to 8.4%. This type of anomaly is classified according to the international guidelines as low-risk, however, at high risk of presenting atheroma, coronary complications,(1) and acute coronary ischemic syndrome due to its occasionally intraarterial pathway. The treatment depends on the complexity of the coronary anatomy. In this case with the presence of total obstruction the correct therapy was to perform a percutaneous coronary angioplasty with drug-eluting stent (DES) placement, which improves the survival and is therapeutic at the acute phase, as in the case of this patient.

Resumen: Presentamos un caso de síndrome isquémico coronario agudo asociado al origen anómalo de la arteria circunfleja, a partir del seno coronario derecho independiente de la arteria coronaria derecha, que tiene una prevalencia de 0.1 a 8.4%. Este tipo de anomalía se clasifica según las guías internacionales como de bajo riesgo; sin embargo, con alto riesgo de presentar desarrollo de ateroma y complicaciones coronarias, síndrome isquémico coronario agudo debido a su trayecto en ocasiones intraarterial. El tratamiento depende de la complejidad de la anatomía coronaria. En este caso de obstrucción total, la terapéutica correcta fue realizar angioplastia coronaria percutánea con la colocación de stent fármaco activo, lo que mejora la sobrevida y es terapéutico en el momento agudo, como en el caso de este paciente.

The value of MSCTA in detecting anomalous origin of coronary artery / 实用放射学杂志

Objective To evaluate the value of multi-slice spiral computed tomography angiography(MSCTA)scanning and reconstruction technology in detecting anomalous origin of coronary artery(AOCA).Methods Retrospective analysis was done in 3 856 patients who accepted MSCTA.Volume rendering(VR),multi-planar reformation(MPR),curved planar reformation(CPR)and maximum intensity projection(MIP)were used to observe the origin and course of coronary artery.Results 42 patients with AOCA were detected among 3 856 objects,and the detection rate was 1.09%.The detection rates had no statistically significant difference between male(1.17%)and female(0.98%).The rate of patients with anomalous origin of left coronary artery was 30.95%(13/42), and 9 objects(69.23%,9/13)of them had the anomalous origin of left circumflex.The rate of patients with anomalous origin of right coronary was 66.67%(28/42),and 35.71% of them(17/28)were found to have the anomalous origin of right coronary artery from the left sinus of valsalva.Conclusion MSCTA scanning and reconstruction technology is noninvasive,rapid,accurate and intuitive.

A case report of left coronary artery originated from the right coronary sinus in child / 天津医药

Anomalous coronary artery origin includes a variety of congenital coronary vascular variations. The left main coronary artery opening in the right coronary sinus is a rare and serious coronary artery malformation. The symptoms of angina, syncope and myocardial ischemia were found in this patient, but some patients showed no clinical symptoms and died suddenly after strenuous exercise. To improve the understanding of the disease early, the early surgery is the key to improve the prognosis.

Cardiopulmonary bypass weaning difficulty due to anomalous origin of coronary artery: A case report / 대한마취과학회지

We report a case of hemodynamic instability after aortic valve replacement, due to the anomalous origin of the right coronary artery. During the cardiopulmonary bypass weaning process, hemodynamic instability occurred. The cause was not identified at first, and compression of the anomalous right coronary artery was thought to be the culprit, thereafter.

A Case of Acute Myocardial Infarction with the Anomalous Origin of the Right Coronary Artery from the Ascending Aorta above the Left Sinus of Valsalva and Left Coronary Artery from the Posterior Sinus of Valsalva

Coronary anomalies are rare angiographic findings. Moreover, there are few reports of cases of an anomalous origin of the right coronary artery from the left sinus of Valsalva and of the left coronary artery from the posterior sinus of Valsalva. Here, we report a case with an anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva and the left coronary artery from the posterior sinus of Valsalva. This was observed in a patient who was treated for a myocardial infarction of the inferior wall caused by a thrombus in the proximal right coronary artery. The patient was treated successfully with the implantation of a stent in the anomalous origin of the right coronary artery using a 6Fr Amplatz left 1 catheter.

A Case of Anomalous Origin of the Left Coronary Artery from the Right Coronary Sinus in a 15-year-old Boy Suffered from Exertional Syncope

We report a case of an anomalous origin of the left coronary artery from the right aortic sinus in young boy with exertional syncope. A 15-year-old boy was admitted to the hospital because of severe retrosternal chest pain followed by syncope during exertion. He had a similar history of syncope during exercise previously. On site transthoracic echocardiography showed that abnormal color mosaics course between aorta and pulmonary artery, suggesting the anomalous left coronary artery originated from the right aortic sinus, and the definite diagnosis was made by multidetector computed tomography (MDCT) thereafter. Coronary angiography showed anomalous origin of the left main coronary artery (LMCA) from the right coronary sinus. The right coronary artery was normal. Mid portion of the LMCA was angulated and narrowed significantly. Surgical correction of the left coronary artery by reimplantation of the ostium to the left aortic sinus and augmentation of the ostium using oval vein patch was performed successfully.

A Case of Anomalous Origin of the Left Coronary Artery from the Right Coronary Sinus in a 15-year-old Boy Suffered from Exertional Syncope

We report a case of an anomalous origin of the left coronary artery from the right aortic sinus in young boy with exertional syncope. A 15-year-old boy was admitted to the hospital because of severe retrosternal chest pain followed by syncope during exertion. He had a similar history of syncope during exercise previously. On site transthoracic echocardiography showed that abnormal color mosaics course between aorta and pulmonary artery, suggesting the anomalous left coronary artery originated from the right aortic sinus, and the definite diagnosis was made by multidetector computed tomography (MDCT) thereafter. Coronary angiography showed anomalous origin of the left main coronary artery (LMCA) from the right coronary sinus. The right coronary artery was normal. Mid portion of the LMCA was angulated and narrowed significantly. Surgical correction of the left coronary artery by reimplantation of the ostium to the left aortic sinus and augmentation of the ostium using oval vein patch was performed successfully.

Anomalous Origin of the Left Coronary Artery Leading to Myocardial Infarction in a 14-year-old Boy

An anomalous origin of the coronary artery is an infrequent but significant cause of myocardial ischemia and sudden death. A left coronary artery arising from the right sinus of Valsalva is of clinical value due to its possible association with sudden cardiac death, particularly when it courses between the aorta and pulmonary trunks. Nevertheless, it is amenable to appropriate surgical intervention, thereby emphasizing the importance of clinical suspicion and timely identification. We report the case of a 14-year-old boy, who presented with acute myocardial infarction of the anterior wall, with an anomalous left coronary artery originating from the right sinus of Valsalva. Transthoracic echocardiographic evaluations of the anomalous origin of the coronary artery and Doppler finding of a 'finger-tip phenomenon', which can be observed under circumstances of myocardial bridging, allowed the diagnosis of this anomaly.

Two Cases of Anomalous Origin of Coronary Artery

Anomalous origin of coronary artery is a relatively rare disordes which is often associated with hypertension and valvular geart desease and in some instances lead to sudden death.Among 1,100 patients who underwent diagnosis coronary angiography at Yonsei Uiversity Medical Center, severance hospital, we found 2 patients with anomalous aortic origin of coronary arteries.In one patient, single coronary artery originated from ascending aorta 1.5cm above the left aortic sinus and in another patient, the origin of the orifice of the right coronary artery separately from the left aortic sinus.