Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography

Frommelt, Peter C.; Lopez, Leo; Dimas, Vasiliki V; Eidem, Benjamin W.; Han, Bo; Ko, H. Helen; Lorber, Richard; Nii, Masaki; Printz, Beth F.; Srivastava, Shubhika; Valente, Anne Marie; Cohen, Meryl S.

doi:10.1016/j.echo.2019.10.011

Cited by 87 publications

(73 citation statements)

References 185 publications

(214 reference statements)

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“…There are also reports of an association between VCACs and progressive myocardial damage in the left ventricle. 14 -16 Although our numbers are small, closure of the VCACs was done without increased mortality. This more aggressive approach to the treatment of the VCACs has been described previously.…”

Section: Commentmentioning

confidence: 88%

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Survival With Respect to Morphology in Pulmonary Atresia and Intact Ventricular Septum in Sweden

Manhem

Hanséus

Berggren

et al. 2021

World J Pediatr Congenit Heart Surg

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Background: Patients born with pulmonary atresia and intact ventricular septum represent a challenge to pediatric cardiologists. Our objective was to study changes in survival with respect to morphology in all children born with pulmonary atresia and intact ventricular septum in Sweden during 36 years. Methods: A retrospective, descriptive study based on medical reports and echocardiographic examinations consisting of those born between 1980 and 1998 (early group) and those born between 1999 and 2016 (late group). Results: The cohort consists of 171 patients (early group, n = 86 and late group, n = 85) yielding an incidence of 4.35 and 4.46 per 100,000 live births, respectively. One-year survival in the early group was 76% compared to 92% in the late group ( P = .0004). For patients with membranous atresia, one-year survival increased from 78% to 98%, and for muscular pulmonary atresia, from 68% to 85%. In patients with muscular pulmonary atresia and ventriculocoronary arterial communications, there was no significant increase in survival. Risk factors for death were being born in the early time period hazard ratio (HR), 6; 95% CI (2.33-14.28) P = .0002, low birth weight HR, 1.26; 95% CI (1.14-1.4) P < .0001 and having muscular pulmonary atresia HR, 3.74; 95% CI (1.71-8.19) P = .0010. Conclusion: The incidence of pulmonary atresia and intact ventricular septum remained unchanged during the study period. Survival has improved, especially for patients with membranous pulmonary atresia, while being born with muscular pulmonary atresia is still a risk factor for death. To further improve survival, greater focus on patients with muscular pulmonary atresia and ventriculocoronary arterial communications is required.

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Section: Commentmentioning

confidence: 88%

“…To delineate the coronary arteries, angiography is still the golden standard, though computed tomography is becoming an informative tool. 14…”

Section: Commentmentioning

confidence: 99%

Survival With Respect to Morphology in Pulmonary Atresia and Intact Ventricular Septum in Sweden

Manhem

Hanséus

Berggren

et al. 2021

World J Pediatr Congenit Heart Surg

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“…16 The echocardiographic assessment of AAOCA is generally done from the PSAX, focused on the aortic root, trying to visualise the origin and the proximal course of the coronary arteries. 1 Other acoustic windows are possible, along with a color-Doppler evaluation and probe tilts to off-axis views, 11 but they are less implemented in everyday practice, excluding specialised centres in paediatric cardiology and congenital heart diseases. 6 The present study adds to previous literature by demonstrating that a standardised and routinely performed approach can ameliorate the sensitivity of the sonographic evaluation of the AAOCA.…”

Section: Discussionmentioning

confidence: 99%

“…Since the coronaries usually have low-velocity flow, the Nyquist limit was decreased to 20-40 cm/s, as recommended. 11 A hallmark of AAOCA was considered the absence of a proper visualisation of the origin of the coronary arteries from the aortic root (figure 3, panels A and B) at the PSAX. 3 12 In addition, their origin and the proximal course can be evaluated from the apical 5-chambers view, focused again on the aortic root (figure 3, panel E).…”

Section: Anomalous Aortic Origin Of Coronary Arteries Definitionmentioning

confidence: 99%

“…3 Besides, its absence can be pathognomonic LAD agenesis or hypoplasia. 11 From the apical 4-chambers view, if a coronary artery is visualised running through the left atrioventricular groove (figure 3, panel F), instead of the right atrioventricular one (figure 2, panel D), a coronary retro aortic course could be suspected in both cases: LCX or LAD from the right coronary sinus. 6 11 Usually, ACAPA are rare and do not present with a predictable pattern imaged with specific echocardiographic views.…”

Section: Anomalous Aortic Origin Of Coronary Arteries Definitionmentioning

confidence: 99%

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Echocardiographic screening for the anomalous aortic origin of coronary arteries

et al. 2021

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AimsWe sought to determine the diagnostic performance, clinical profiles and outcomes of anomalous aortic origin of coronary arteries (AAOCA) using a standardised echocardiographic approach in young adults and athletes.MethodsIn 2015–2019, we screened 5998 outpatients (age 16 years (Q1–Q3: 11, 36)), referred for routine echocardiography, using four specific echocardiographic windows: parasternal short/long axis and apical 4/5-chambers view. Coronary CT confirmed AAOCA. For the performance analysis, 300 coronary-CT scans were available; two independent and double-blinded physicians retrospectively reviewed echocardiographic images.ResultsA total of 47 AAOCA was diagnosed; the overall prevalence was 0.0078%. Over 5 years, we found a significant increment of AAOCA diagnostic rate (P for trend=0.002). Syncope (n=17/47) and palpitations (n=6/47) were prevalent symptoms. All patients suspended sports activity at the diagnosis. Twenty-seven patients underwent surgery, while 20 underwent a conservative medical treatment. All patients are alive at a median follow-up of 3±1.6 years; only surgical repairs restarted their activity. Our method showed better sensitivity than traditional short-axis evaluation: 93% vs 83%, p=0.0030 (AUC 0.96 (95% CI 0.92, 0.99) and AUC 0.89 (95% CI 0.83, 0.95), respectively), with a good interobserver agreement (95%, k=0.83, p<0.001).ConclusionsThe application of a standardised echocardiographic approach for AAOCA detection led to a significantly increased rate of identified anomalies. This approach demonstrated higher sensitivity than the traditional echocardiographic assessment. Implementing this protocol in clinical practice may help improve the AAOCA diagnosis in young adults and athletes.Trial registration numberNCT04224090.

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Congenital Anomalies of the Coronary Arteries

Srivastava

Barker

2021

Echocardiography in Pediatric and Congenital Heart Disease

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Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography

Cited by 87 publications

References 185 publications

Survival With Respect to Morphology in Pulmonary Atresia and Intact Ventricular Septum in Sweden

Survival With Respect to Morphology in Pulmonary Atresia and Intact Ventricular Septum in Sweden

Echocardiographic screening for the anomalous aortic origin of coronary arteries

Congenital Anomalies of the Coronary Arteries

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