Evaluation of Abnormal Coronary Artery Flow in Anomalous Coronary Artery Connections by Pulsed and Color Doppler Echocardiography

Hong, Young Mi

Abstract

PURPOSE: Anomalous connection of coronary artery can result in damage of myocardial perfusion, myocardial infarction, or congestive heart failure. Echocardiography has been used to demonstrate coronary artery anomalies such as coronary artery fistula, anomalous origin of the left coronary artery from the pulmonary artery, and aneurysm of the coronary arteries in Kawasaki disease. Definitive diagnosis relies on cardiac catheterization The objectives of this study were to know the diagnostic sensitivity of echocardiography in detecting abnormal coronary artery connections, and identify the direction of blood flow by pulsed Doppler echocardiography in these patients.
METHODS
Evidence of abnormal connections were found during echocardiographic examination in 25 patients(anomalous origin of left coronary artery from the pulmonary artery, coronary artery fistula, right ventricular to coronary artery sinusoids in pulmonary atresia with intact ventricular septum, and left ventricular to coronary artery sinusoids in aortic atresia with intact venticular septum). Two-dimensional imaging, color and pulsed Doppler echocardiography were performed in supine or left decubitus position from parasternal, apical, and subcostal views. The internal dimension of the coronary arteries and aortic root were measured at the level of aortic annulus during systole from the parastenal short axis view.
RESULTS
1) Diagnostic sensitivity by echocardiography in anomalous origin of the left coronary artery from the pulmonary artery was 85.7%(6/7). The direction of flow was from the left coronary artery into pulmonary artery during systole and reversed flow in diastole in 4 patients. There was continuous flow from the left coronary artery to the pulmonary artery in 1 patient. 2) Diagnostic sensitivity by echocardiography in congenital coronary artery fistula was 85.7% (6/7), and in acquired coronary artery fistula was 100%(4/4). There was continous systolic and diastolic flow from the coronary artery into the right ventricle or pulmonary artery by pulsed Doppler in all patients. 3) Diagnostic sensitivity in coronary sinusoid was 100% (7/7). Pulsed Doppler echocardiography revealed systolic flow from the right or left ventricle into coronary circulation during systole, and reversed flow during diastole.
CONCLUSIONS
Color and pulsed Doppler echocardiography is extremely useful in detecting abnormal coronary artery connections. Although the sensitivity of echocardiography to coronary artery abnormalities is not 100%, there was no false positive. Cardiac catheterization may be necessary to confirm the diagnosis, but echocardiography is a helpful diagnostic tool in high risk infnats.