High-risk anatomical features: a new perspective on refined echocardiographic diagnosis of anomalous coronary artery origin from the opposite sinus.

BACKGROUND

The aim of this study was to explore the value of echocardiography in diagnosing anomalous origin of the coronary artery from the opposite sinus (ACAOS) and to summarize the high-risk anatomical features associated with intramural and non-intramural courses. MATERIALS AND

METHODS

A retrospective analysis was performed on echocardiograms of 24 patients with surgically confirmed ACAOS (median age 23.5 years; 12 males and 12 females) at Wuhan Union Hospital between May 2021 and January 2025. Patients were divided into intramural (n = 11) and non-intramural (n = 13) course subgroups. Parameters including take-off angle, thickness between the coronary artery and aortic intima, and proximal segment diameter were compared.

RESULTS

Intramural courses were identified using “intra-ring sign,” and “thin-wall sign,” while non-intramural courses were characterized by “sandwich sign” and “extra-ring sign.” The initial recognition of intramural segments was 36.36%, leading to an overall diagnostic accuracy of 62.50%. After specialized training, diagnostic accuracy improved significantly to 87.50% (p = 0.031). Comparative analysis showed that the non-intramural subgroup had significantly greater intima-to-intima wall thickness (2.63 ± 0.13 mm vs. median 1.03 mm, p < 0.001) and larger take-off angle (34.51 ± 1.24° vs. 27.76 ± 0.58°, p = 0.025), while proximal segment diameter showed no significant difference (p = 0.119).

CONCLUSION

This study proposes specific echocardiographic signs for diagnosing high-risk anatomical features in ACAOS. Specialized training significantly improves the detection rate of malignant coronary courses, enhancing the clinical utility of echocardiography.