Highlights
- •TTE can reliably identify or suspect the presence of AAOCA in expert hands.
- •Advanced imaging with CCTA is crucial for further detailed anatomic definition of the anomalous origin and course.
- •CCTA findings might have major implications on clinical decision-making.
Abstract
Background and objective
There is limited literature comparing TTE and CCTA in children with suspected AAOCA.
To determine the distribution of various coronary anomalies comparing TTE and CCTA
data, and define the added value advanced imaging brings in clinical decision-making.
Materials and methods
Retrospective review of data was obtained in patients aged 0–18 years who underwent
TTE and CCTA for suspected AAOCA. Patient demographics, CCTA and TTE findings, and
interventions performed were recorded.
Results
100 consecutive patients were included (60% male), mean age 11 years (7 days-18 years
old). In 93 patients, CCTA detected 94 anomalous coronaries. Definitive coronary abnormality
was reported on TTE in 77 patients; 76 of which were confirmed by CCTA, 1 patient
was found to have a normal variant. Suspected anomalous origin was reported in 16
patients on TTE, 13 of which were abnormal on CCTA. The coronary origin was not seen
on TTE in 6 patients; of these, 3 had AAOCA on CCTA and 3 had hypoplastic RCA with
left dominant system. Only 1 patient who had a normal TTE was found to have AAOCA
on CCTA.
CCTA was better than TTE in defining ostial characteristics and the course of the
anomalous coronary artery, and detecting myocardial bridge.
Conclusions
CCTA adds value in diagnosing AAOCA when the coronary origins are not well assessed
or suspected anomalous origin is suggested on TTE. In addition, when a confident definitive
diagnosis of AAOCA is reported on TTE, CCTA demonstrates better performance in determining
additional features of AAOCA.
Keywords
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Article info
Publication history
Published online: January 12, 2023
Accepted:
January 8,
2023
Received in revised form:
December 22,
2022
Received:
October 24,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
