Abstract
When the anomalous origin of coronary arteries (AOCA) is suspected in children (especially
athletes), due to signs and symptoms of myocardial ischemia or on the basis of echocardiographic
assessment, three-dimensional coronary magnetic resonance angiography (3D-CMRA) can
be proposed for the fine morphological evaluation of coronary branches anatomy and
course.
We tested the diagnostic potential of CMRA angiography in a prospective study on AOCA
in young patients. Between July 2005 and June 2008, 15 patients aged 6–29 years (mean
age, 13.5 years±5.6 S.D.; median, 14) with clinical and echocardiographic suspicion
of AOCA underwent CMRA (1.5 T), 3D whole-heart, free-breathing technique, without
the use of contrast medium and β-blockers, with a mean examination time of 30 min.
We acquired a second scan of all patients to ameliorate the quality of the acquisition
and to improve our experience.
AOCA was confirmed by 3D-CMRA in 8 out of 15 cases (53%) and three different anatomical
variants were demonstrated, that is, ectopic origin of the left circumflex artery
arising from the right coronary artery with retro-aortic course in four cases, single
coronary artery arising from the right sinus of Valsalva with interarterial course
in one case, ectopic right coronary artery arising from the left sinus of Valsalva
with interarterial course in one case; in two patients without anomalies of origin
of the coronary arteries, elongated LMCA with angulation of the proximal segment of
the left circumflex artery was present.
When AOCA is suspected particularly in children (especially athletes), CMRA without
the use of contrast medium is an effective diagnostic technique, which is useful to
clarify the spatial position of the anomalous course of the main coronary branches
in order to suggest the most convenient management of the disease. CMRA does not need
contrast medium, needles, and β-blockers; is repeatable in the same examination without
the exposure to X-rays; allows a parent to stay near the child; and needs low collaboration
in low-stress conditions.
Keywords
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Article info
Publication history
Published online: December 03, 2009
Accepted:
August 24,
2009
Received:
July 22,
2009
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
