Diagnosis and treatment of anomalous aortic origin of a coronary artery from the opposite sinus in children and adolescents

Abstract

Objective To observe the clinical characteristics and improve the diagnosis and treatment of anomalous aortic origin of a coronary artery from the opposite sinus (AAOCA) in children and adolescents. Methods Between January 2012 and December 2016, 11 children/adolescents [8 were boys, 3 were girls, age was (10.1±5.6) years old] diagnosed with AAOCA were retrospectively reviewed at Department Pediatric Cordiology, Guangdong General Hospital.The clinical features, transthoracic echocardiography (TTE), computed tomography images, electrocardiogram (ECG), cardinc troponin I(CTnI) and creatinine kinase-MB(CK-MB) were analyzed. Results The diagnosis of AAOCA was confirmed by TTE and computed tomography images in all 11 cases.Left coronary artery originated from the right sinus in 5 patients, and right artery coronary originated from the left sinus in 6 cases.Five patients with intramural course had the history of exercise-related syncope.Of these 5 cases with exercise-related syncope, 4 cases were diagnosed as left coronary artery originated from the right sinus and 1 case was diagnosed as right artery coronary originated from the left sinus.ECG, CTnI and CK-MB revealed acute myocardial ischemia in these patients with exercise-related syncope.Unroofing procedures were undergone in these 5 patients.The remaining 6 patients had no syncope and symptoms of cardia ischemia, sports activities were restricted and follow-ups were counseled in these 6 patients.There was no sudden death events later, and none of the patients demonstrated any evidence of new myocardial ischemia in the follow-up study. Conclusions AAOCA can be associated with syncope and myocardial ischemia in children and adolescents.The correct diagnosis of AAOCA requires a very high index of suspicion.Sports activities restriction and follow-up should be counseled in cases with AAOCA.Unroofing procedures should be performed in symptomatic cases with AAOCA and an intramural course. Key words: Coronary vessel anomalies; Exercise-related syncope; Sudden cardiac death; Adolescents; Child