Diagnosis and treatment of anomalous aortic origin of a coronary artery from the opposite sinus in children and adolescents / 中华实用儿科临床杂志

ABSTRACT

Objective To observe the clinical characteristics and improve the diagnosis and treatment of anomalous aortic origin of a coronary artery from the opposite sinus (AAOCA)in children and adolescents. Methods Between January 2012 and December 2016,11 children/ adolescents [8 were boys,3 were girls,age was (10. 1 ± 5. 6) years old]diagnosed with AAOCA were retrospectively reviewed at Department Pediatric Cordiology,Guangdong General Hospital. The clinical features,transthoracic echocardiography (TTE),computed tomography images,electro-cardiogram (ECG),cardinc troponin I(CTnI)and creatinine kinase - MB(CK - MB)were analyzed. Results The di-agnosis of AAOCA was confirmed by TTE and computed tomography images in all 11 cases. Left coronary artery origina-ted from the right sinus in 5 patients,and right artery coronary originated from the left sinus in 6 cases. Five patients with intramural course had the history of exercise - related syncope. Of these 5 cases with exercise - related syncope,4 cases were diagnosed as left coronary artery originated from the right sinus and 1 case was diagnosed as right artery coronary originated from the left sinus. ECG,CTnI and CK - MB revealed acute myocardial ischemia in these patients with exercise - related syncope. Unroofing procedures were undergone in these 5 patients. The remaining 6 patients had no syncope and symptoms of cardia ischemia,sports activities were restricted and follow - ups were counseled in these 6 patients. There was no sudden death events later,and none of the patients demonstrated any evidence of new myocardial ischemia in the follow - up study. Conclusions AAOCA can be associated with syncope and myocardial ischemia in children and adolescents. The correct diagnosis of AAOCA requires a very high index of suspicion. Sports activities restriction and follow - up should be counseled in cases with AAOCA. Unroofing procedures should be performed in symptomatic cases with AAOCA and an intramural course.