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Identification, imaging, functional assessment and management of congenital coronary arterial abnormalities in children

Published online by Cambridge University Press:  26 November 2007

Alan H. Friedman ,
Mark A. Fogel ,
Paul Stephens Jr. ,
Jeffrey C. Hellinger ,
David G. Nykanen ,
James Tweddell ,
Timothy F. Feltes  and
Jonathan J. Rome
Alan H. Friedman*
Affiliation:
Section of Pediatric Cardiology, Yale University and the Yale New Haven Children’s Hospital, New Haven, Connecticut, United States of America
Mark A. Fogel
Affiliation:
Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Paul Stephens Jr.
Affiliation:
Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Jeffrey C. Hellinger
Affiliation:
Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
David G. Nykanen
Affiliation:
Congenital Heart Institute at Arnold Palmer Hospital and Miami Children’s Hospital, Miami, Florida, United States of America
James Tweddell
Affiliation:
Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, United States of America
Timothy F. Feltes
Affiliation:
Ohio State University and Columbus Children’s Hospital, Columbus, Ohio, United States of America
Jonathan J. Rome
Affiliation:
Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
*
Correspondence to: Alan Friedman, MD, Associate Professor of Pediatrics and Associate Chair of Pediatrics, Education, Yale University School of Medicine, 333 Cedar Street, LCI 302, New Haven, CT 06520-8064; Tel: 203 785-2022; Fax: 203 737 2786; E-mail: [email protected]
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Abstract

The coronary arteries, the vessels through which both substrate and oxygen are provided to the cardiac muscle, normally arise from paired stems, right and left, each arising from a separate and distinct sinus of the aortic valve. The right coronary artery runs through the right atrioventricular groove, terminating in the majority of instances in the inferior interventricular groove. The main stem of the left coronary artery bifurcates into the anterior descending, or interventricular, and the circumflex branches. Origin of the anterior descending and circumflex arteries from separate orifices from the left sinus of Valsalva occurs in about 1% of the population, while it is also frequent to find the infundibular artery arising as a separate branch from the right sinus of Valsalva.

Anomalies of the coronary arteries can result from rudimentary persistence of an embryologic coronary arterial structure, failure of normal development or normal atrophy as part of development, or misplacement of connection of a an otherwise normal coronary artery. Anomalies, therefore, can be summarized in terms of abnormal origin or course, abnormal number of coronary arteries, lack of patency of the orifice of coronary artery, or abnormal connections of the arteries.

Anomalous origin of the left coronary artery from the pulmonary trunk occurs with an incidence of approximately 1 in 300,000 children. The degree of left ventricular dysfunction produced likely relates to the development of collateral vessels that arise from the right coronary artery, and provide flow into the left system. Anomalous origin of either the right or the left coronary artery from the opposite sinus of Valsalva can be relatively innocuous, but if the anomalous artery takes an interarterial course between the pulmonary trunk and the aorta, this can underlie sudden death, almost invariably during or immediately following strenuous exercise or competitive sporting events. Distal anomalies of the coronary arteries most commonly involve abnormal connections, or fistulas, between the right or left coronary arterial systems and a chamber or vessel.

We discuss the current techniques available for imaging these various lesions, along with their functional assessment, concluding with a summary of current strategies for management.

Keywords

Sudden deathmagnetic resonance imagingcomputerized tomography
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Supplement S4 , September 2007 , pp. 56 - 67
Copyright
Copyright © Cambridge University Press 2007

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References

1. Roberts, WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J 1986; 111: 941–963.CrossRefGoogle ScholarPubMed
2. Keith, J. Diseases of coronary arteries and aorta. In: Keith, J, Rowe, R, Vlad, P (eds). Heart disease in infancy and childhood. Macmillan, New York, 1978, pp 278–279.Google Scholar
3. Neufeld, HN, Schneeweis, A. Coronary artery disease in infants and children. Lea & Febiger, Philadelphia, 1983.Google Scholar
4. Wesselhoeft, H, Fawcett, JS, Johnson, AL. Anomalous origin of the left coronary artery from the pulmonary trunk: its clinical spectrum, pathology,, and pathophysiology, based on a review of 140 cases with seven further cases. Circulation 1968; 38: 403–425.CrossRefGoogle ScholarPubMed
5. Hayashi, Y, Kishida, K, Haneda, N, Mori, C. A case of Bland-White-Garland syndrome with myocardial infarction on the first day after birth. Pediatr Cardiol 1990; 11: 175–176.CrossRefGoogle ScholarPubMed
6. Roberts, WC, Siegel, RJ, Zipes, DP. Origin of the right coronary artery from the left sinus of valsalva and its functional consequences: analysis of ten necropsy patients. Am J Cardiol 1982; 49: 863–868.CrossRefGoogle Scholar
7. Cheitlin, MD, DeCastro, CM, McAllister, HA. Sudden death as a complication of anomalous left coronary origin from the anterior sinus of Valsalva. Circulation 1974; 50: 780–787.CrossRefGoogle ScholarPubMed
8. Frommelt, PC, Frommelt, MA. Congenital coronary artery anomalies. Pediatr Clin North Am 2004; 51: 1273–1288.CrossRefGoogle ScholarPubMed
9. Eckart, RE, Scoville, SL, Campbell, CL, et al. . Ann Int Med 2004; 141: 829–834.CrossRefGoogle Scholar
10. Lorenz, EC, Mookadam, F, Mookadam, M, Moustafa, S, Zehr, KJ. A systematic overview of anomalous and an examination of the association with sudden cardiac death. Rev Cardiovasc Med 2006; 7: 205–213.Google Scholar
11. Angelini, P, Velasco, JA, Flamm, S. Coronary anomalies:incidence, pathophysiology, and clinical relevance. Circulation 2002; 105: 2449–2454.CrossRefGoogle ScholarPubMed
12. Maron, B, Roberts, WC. Causes and implications of sudden cardiac death in athletes. In: Akhtar, M, Myerburg, RJ, Ruskin, JN (eds). Sudden Cardiac Death. Williams & Wilkins, Philadelphia, 1994, pp 238–255.Google ScholarPubMed
13. Davis, JA, Cecchin, F, Jones, TK, Portman, MA. Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol 2001; 37: 593–597.CrossRefGoogle Scholar
14. Mirchandani, S, Phoon, CKL. Management of anomalous coronary arteries from the contralateral sinus. Int J Cardiol 2005; 102: 383–389.CrossRefGoogle ScholarPubMed
15. Corrado, D, Basso, C, Pavei, A, Michieli, P, Schiavon, M, Thiene, G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006; 296: 1593–1601.CrossRefGoogle ScholarPubMed
16. Corrado, D, Thiene, G, Cocco, P, Frescura, C. Non-atherosclerotic coronary artery disease and sudden death in the young. Br Heart J 1992; 68: 601–607.CrossRefGoogle ScholarPubMed
17. McConnell, MV, Ganz, P, Selwyn, AP, Li, W, Edelman, RR, Manning, WJ. Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography. Circulation 1995; 92: 3158–3162.CrossRefGoogle ScholarPubMed
18. Bunce, NH, Lorenz, CH, Keegan, J, et al. . Coronary artery anomalies: assessment with free breathing three-dimensional coronary MR angiography. Radiology 2003; 227: 201–208.CrossRefGoogle ScholarPubMed
19. Su, JT, Chung, T, Muthupillai, R, et al. . Usefulness of real-time navigator magnetic resonance imaging for evaluating coronary origins in pediatric patients. Am J Cardiol 2005; 95: 679–682.CrossRefGoogle ScholarPubMed
20. Sakuma, H, Ichikawa, Y, Suzawa, N, et al. . Assessment of coronary arteries with total study time of less than 30 minutes by using whole heart coronary MR angiography. Radiology 2005; 237: 316–321.CrossRefGoogle ScholarPubMed
21. Babu-Narayan, SV, Cannell, TM, Mohiaddin, RH. Giant aneurysms of the coronary arteries due to Kawasaki disease--regular review without radiation using cardiovascular magnetic resonance. Cardiol Young 2006; 16: 511–512.CrossRefGoogle ScholarPubMed
22. Mavrogeni, S, Papadopoulos, G, Douskou, M, et al. . Magnetic resonance angiography is equivalent to X-ray coronary angiography for the evaluation of coronary arteries in Kawasaki disease. J Am Coll Cardiol 2004; 43: 649–652.CrossRefGoogle ScholarPubMed
23. Taylor, AM, Dymarkowski, S, Hamaekers, P, et al. . MR coronary angiography and late-enhancement myocardial MR in children who underwent arterial switch surgery for transposition of the great arteries. Radiology 2005; 234: 542.CrossRefGoogle Scholar
24. Mavrogeni, S, Papadopoulos, G, Douskou, M, et al. . Magnetic resonance angiography, function and viability evaluation in patients with Kawasaki disease. J Cardiovasc Magn Resonan 2006; 8: 493–498.CrossRefGoogle ScholarPubMed
25. Prakash, A, Powell, AJ, Krishnamurthy, R, Geva, T. Magnetic resonance imaging evaluation of myocardial perfusion and viability in congenital and acquired pediatric heart disease. Am J Cardiol 2004; 93: 657–661.CrossRefGoogle ScholarPubMed
26. Angelini, P. Normal and anomalous coronary arteries: definitions and classification. Am Heart J 1989; 117: 418–434.CrossRefGoogle ScholarPubMed
27. Okubo, M, Nykanen, D, Benson, LN. Outcomes of transcatheter embolization in the treatment of coronary artery fistulas. Cathet Cardiovasc Interventions 2001; 52: 510–517.CrossRefGoogle ScholarPubMed
28. Guyton, AC, Hall, JE. Textbook of medical physiology, 10th edn. W.B. Saunders, Philadelpha, 2000.Google Scholar
29. Garson, A, Bricker, JT, Fisher, DJ, Neish, SR. The science and practice of pediatric cardiology, 2nd edn. Williams and Wilkins, Baltimore, 1997.Google Scholar
30. Bousfield, G. Angina Pectoris: changes in electrocardiogram during paroxysm. Lancet 1918; 2: 457.CrossRefGoogle Scholar
31. Flynn, B, Wernovsky, G, Summerville, DA, Castaneda, AR, Treves, ST. Comparison of technetium-99 m MIBI and thallium-201 chloride myocardial scintigraphy in infants. J Nucl Med 1989; 30: 1176–1181.Google Scholar
32. Yamazumi, R, Kobayashi, H, Horie, T, et al. . High incidence of false positive results of thallium-201 myocardial stress scintigraphy for the evaluation of artery bypass graft patency after CABG. Japanese J Nucl Med 1995; 32: 271–279.Google ScholarPubMed
33. Kraunz, RF, Kennedy, JW. Ultrasonic determination of left ventricular wall motion in normal man. Studies at rest and after exercise. Am Heart J 1970; 79: 36–43.Google ScholarPubMed
34. Berthe, C, Pierard, LA, Hienaux, M, et al. . Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion. Am J Cardiol 1986; 58: 1167–1172.CrossRefGoogle ScholarPubMed
35. Lang, RM, Bierig, M, Devereux, RB, et al. . Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–1463.CrossRefGoogle Scholar
36. Kimball, TR. Pediatric stress echocardiography. Pediatr Cardiol 2002; 23: 347–357.CrossRefGoogle ScholarPubMed
37. Noto, R. Cardiac applications of positron emission tomography (PET). Medicine and Health, Rhode Island, 2003.Google ScholarPubMed
38. Erez, E, Tam, VKH, Doubin, NA, Stakes, J. Anomalous coronary artery with aortic origin and course between the great arteries: improved diagnosis, anatomic findings, and surgical treatment. Ann Thorac Surg 2006; 82: 973–977.CrossRefGoogle ScholarPubMed
39. Frommelt, PC, Frommelt, MA, Tweddell, JS, Jaquiss, RDB. Prospective Echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with interarterial course. J Am Coll Cardiol 2003; 42: 148–157.CrossRefGoogle ScholarPubMed
40. Mustafa, I, Gula, G, Radley-Smith, R, Durrer, S, Yacoub, M. Anomalous origin of the left coronary artery from the anterior aortic sinus: a potential cause of sudden death. Anatomic characterization and surgical treatment. J Thorac Cardiovasc Surg 1981; 82: 297–300.CrossRefGoogle ScholarPubMed
41. Van Son, JA, Mohr, FW. Modified unroofing procedure in anomalous aortic origin of left or right coronary artery. Ann Thorac Surg 1997; 64: 568–569.CrossRefGoogle ScholarPubMed