Purpose or Case Report: Anomalous Aortic Origin of Coronary Artery (AAOCA) is the 2nd most common cause of sudden cardiac death in the young. Coronary artery origins are evaluated as part of transthoracic echocardiography (TTE) and diagnostic precision may be limited by technical limitations, operator dependence, and patient cooperation. MRI and gated Cardiac Computed Tomographic Angiography (CCTA) are often utilized in patients where an anomaly is suspected on TTE. There is limited literature comparing TTE and CCTA in children with suspected AAOCA. The purpose of this study is 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.
Methods & Materials: Following IRB approval, retrospective review of data was obtained, over a 3 year period, in patients aged 0-18 years who underwent TTE and CCTA for suspected AAOCA . Exclusion criteria included non-diagnostic TTE or CCTA. Patient demographics, CCTA and TTE findings, and interventions performed were recorded.
Results: 100 consecutive patients were included (60 % male), mean age 11 years (7days-18 yrs). All patients had a TTE interpreted by a pediatric cardiologist prior to CCTA with the mean time interval between studies of 80 days (0-257 days). In 93 patients, CCTA detected 94 anomalous coronaries (90 anomalous right coronary artery(RCA), 3 anomalous left coronary and 1 anomalous circumflex arteries). Definitive coronary abnormality was reported on TTE in 77 patients; 76 (99%) of which were confirmed by CCTA, 1 patient was found to have a normal variant. Surgery was performed in 10 patients (13%) in this group. Suspected anomalous origin was reported in 16 patients on TTE, 13 of which were abnormal on CCTA. Surgery was performed in 1 patient in this group (7.7%). Coronary origin was not seen on TTE in 6; 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.


Conclusions: CCTA adds value in diagnosing AAOCA when coronary origins are not well assessed or suspected anomalous origin is suggested on TTE. However, when a confident definitive diagnosis of AAOCA is reported on TTE, CCTA did not yield a change in diagnosis. Thus, the significant contribution of CCTA in patients with AAOCA relates to highly detailed findings on the precise origin/spatial relation, ostial morphology, and course of the anomalous coronary artery.