Diagnostic value of echocardiography on detecting the various types of anomalous origin of the left coronary artery from the pulmonary artery

Yi Yu1, Qun-Shan Wang1, Xi-Fang Wang2, Jian Sun1, Ling-Wei Yu3, Ming Ding3, Yi-Gang Li1

1Department of Cardiology, 2Department of Performance, 3Department of Radiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China

Contributions: (I) Conception and design: Y Yu; (II) Administrative support: YG Li; (III) Provision of study materials or patients: QS Wang, LW Yu; (IV) Collection and assembly of data: J Sun, M Ding; (V) Data analysis and interpretation: XF Wang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Yi Yu, MD, PhD; Yigang Li, MD, PhD. Department of Cardiology, Xinhua Hospital affiliated with the School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai 200092, China. Email: yuyi01@xinhuamed.com.cn; liyigang@xinhuamed.com.cn.

Background: To assess the diagnostic value of echocardiography in detecting the various types of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).

Methods: A total of 30 patients with an established diagnosis of ALCAPA were retrospectively analyzed, and classified into infant- (n=20) and adult-type (n=10) groups according to the age of symptom manifestation and the mode of presentation. All patients underwent echocardiography examination.

Results: Twenty-four out of thirty patients were diagnosed with ALCAPA by echocardiography. The remaining six cases were confirmed by dual-source computed tomography (DSCT) and angiocardiography, respectively. In the infant-type group, there was negligible or no collateral flow between the right coronary artery (RCA) and the left coronary artery (LCA). Eighteen of these patients had enhanced echogenicity of left ventricular (LV) papillary muscles, different degrees of mitral regurgitation (MR) and the RCA to aortic annulus ratio (RCA/AO) was >0.12. In the adult-type group, all ten patients had RCA dilation and significant development of collateralization from the RCA to the dilated LCA. They all had mild MR and RCA/AO was >0.20. Preoperatively, left ventricular ejection fraction (LVEF) was significantly lower in infant-type group than in adult-type group (46.24%±5.47% vs. 61.43%±6.38%, P<0.01). Cardiac surgery significantly improved post-operative LVEF (60.12%±6.02%, P<0.01 vs. pre-operation) in infant-type group.

Conclusions: Echocardiography plays a pivotal role in detecting ALCAPA. Imaging and clinical features differ significantly between infant- and adult-type cases.

Keywords: Echocardiography; anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA); infant; adult