Pathology of coronary arteries in children and its clinical significance

Abstract

Annotation. Coronary insufficiency and associated ischemic heart disease are most common among adult patients, while life-threatening myocardial ischemia can develop in childhood and clinically debut as a sudden death syndrome. In children and young adults, the most frequent cardiac causes of sudden death syndrome include hypertrophic cardiomyopathy, coronary artery anomalies, other phenotypes of myocardial pathology, and myocarditis. Anomalies of the coronary arteries cause significant difficulties in diagnostics because they have a wide clinical polymorphism – from asymptomatic variants to severe myocardial dysfunction due to ischemia, and also require special knowledge and skills when using modern methods of imaging the heart and its structures. The work is devoted to the analysis of the etiology of coronary artery disease in childhood and is aimed at increasing the awareness of the medical community about this problem. The Cochrane Library, Pub Med and Google Scholar reference databases were used for the review. 84 articles were studied and analyzed, 29 sources were included in the review. Myocardial ischemia in childhood and associated severe myocardial dysfunction are most often the result of congenital anomalies of coronary artery development, coronary artery pathologies in the composition of other congenital heart defects, coronary artery damage in Kawasaki disease, and coronary insufficiency in patients with hypertrophic cardiomyopathy. It is important to note that coronary vessel anomalies can often be asymptomatic and not detected during routine clinical examination, but manifest themselves in young and even adult life in the form of acute myocardial ischemia and cardiogenic shock against the background of complete well-being. During echocardiographic screenings it is necessary to pay attention to the anatomy of the coronary arteries. Also a multidisciplinary approach to the management of children with diseases in which coronary artery damage is possible is necessary.