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Transthoracic echocardiography features of adult-type anomalous left coronary artery from the pulmonary artery before and after surgery: highlights from observational study in a single center of China

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Abstract

To review the imaging characteristics of adult-type anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and evaluate the post-operative echocardiographic features. The transthoracic echocardiography (TTE) records and invasive coronary angiography (ICA), coronary computed tomography angiography (CTA) or operative findings of thirty adult patients with final diagnosis of ALCAPA were reviewed at our center. The diagnostic reliability of TTE was determined by comparing its results with that of ICA/CTA, and the echocardiographic features of the patients during early visit and post-operative follow-up were summarized. The coincidence rate of TTE and ICA/CTA diagnosing ALCAPA was 96.3% (26/27), and one case was misdiagnosed as coronary artery fistula. All patients showed abnormal left coronary ostium arising from the pulmonary trunk with retrograde coronary artery flow, 20 patients had enlarged right coronary artery (RCA), and 20 showed abundant inter-coronary septal coronary collaterals. Left ventricle (LV) abnormalities such as wall thinning, abnormal wall motion, papillary muscle fibrosis, mitral valve (MV) prolapse and moderate-severe mitral regurgitation (MR) were respectively observed in 4, 7, 10, 8 and 10 patients. Three patients showed ventricular septal defect, patent foramen ovale and tetralogy of Fallot respectively. Post-operative data was available for 12 patients, and showed that the diameter of RCA, size of left atrium (LA) and LV were decreased after surgery compared to the respective pre-operative values. Furthermore, inter-coronary septal coronary collaterals lessened in 8 of these patients. Although 6 patients showed residual mild MR, moderate or severe MR was not observed, and the ejection fraction (EF) also showed no obvious changes before and after surgery. TTE is a non-invasive diagnostic tool for adult-type ALCAPA, and can indicate abnormal coronary origin, collateral arteries and other associated malformations. Some of the structural and hemodynamic parameters of adult-type ALCAPA were improved after surgery.

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Data availability

The data that support the findings of this study are available on request. The data are not publicly available due to the containing information that could compromise the privacy of research participants.

Abbreviations

ALCAPA:

Anomalous origin of the left coronary artery from the pulmonary artery

RBF:

Retrograde blood flow in the LCA

CDI:

Color Doppler imaging

CTA:

Computed tomography angiography

EF:

Ejection fraction

ICA:

Invasive coronary angiography

LA:

Left atrium

LCA:

Left coronary artery

LV:

Left ventricle

LVEDD:

LV end-diastolic diameter

LVESD:

LV end-systolic diameter

MR:

Mitral regurgitation

MV:

Mitral valve

RCA:

Right coronary artery

TTE:

Transthoracic echocardiography

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Funding

This study was supported by Guangdong Provincial People's Hospital Hospital Science and Technology Special Project (No. 2017zh04); Guangzhou Science and Technology Key Project (201904010448); Guangdong Provincial Science and Technology Planning Project (No. 2014A020212676).

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Author notes

  1. Mingqi Li and Yu Wang have contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, China

    Mingqi Li, Yu Wang, Wei Zhu, Caojin Zhang & Hongwen Fei

  2. Shantou University Medical College, Shantou, Guangdong, China

    Mingqi Li & Yu Wang

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  1. Mingqi Li
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  2. Yu Wang
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Contributions

ML and YW carried out the studies, participated in data collection, performed the statistical analysis and drafted the manuscript under the supervision of HF. WZ helped to proofreaded manuscript. CZ helped to collect surgical information. All authors read and approved the final manuscript.

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Correspondence to Hongwen Fei.

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We declare that we have no significant competing financial, professional, or personal interests that might have influenced the performance or presentation of the work described in this manuscript.

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Li, M., Wang, Y., Zhu, W. et al. Transthoracic echocardiography features of adult-type anomalous left coronary artery from the pulmonary artery before and after surgery: highlights from observational study in a single center of China. Int J Cardiovasc Imaging 36, 1477–1487 (2020). https://doi.org/10.1007/s10554-020-01857-x

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