Echocardiographic diagnosis of interarterial AAOCA in children: a framework integrating anatomical landmarks and systolic dysfunction for risk assessment.

BACKGROUND

Anomalous aortic origin of coronary arteries (AAOCA) with interarterial course poses life-threatening risks in pediatric patients, yet standardized preoperative imaging protocols remain limited. This study aims to establish a systematic echocardiographic framework for AAOCA diagnosis.

METHODS

A Retrospective Analysis of Ultrasound Images in 11 Cases of AAOCA with Interarterial Course. Among them, 8 cases presented abnormalities with the right coronary artery originating from the left coronary sinus (Anomalous Right Coronary Artery, ARCA), while 3 cases exhibited abnormalities with the left coronary artery originating from the right coronary sinus (Anomalous Left Coronary Artery, ALCA). The ultrasound features are summarized, and left ventricular ejection fraction (LVEF) and segmental wall motion were quantitatively assessed via Simpson’s method.

RESULTS

Four distinct echocardiographic features were identified: (i) Ostial deviation: ARCA at 1–3 o’clock, ALCA at 11 − 1 o’clock (10/11 definitive, 1/11 suspected); (ii) Acute angle: Mean angle 43°±8° vs. normal 90°±5° (P < 0.001); (iii) Parallel course sign: All cases exhibited proximal coronary adherence to the aortic wall (Fig. 2); (iv) Diastolic flow acceleration: Detected in intramural/stenotic segments (peak velocity > 50 cm/s; Fig. 3). Prior to surgery, the 11 cases of AAOCA exhibited varying degrees of symptoms such as chest tightness, chest pain, and even syncope. ARCA (median 64.1%, IQR 62.3–67.4%) versus severely reduced in ALCA (median 39.2%, IQR 33.8–43.6%; P < 0.001, Mann-Whitney U test), with ALCA cases showing more extensive wall motion abnormalities (3/3 vs. 2/8; P = 0.048). Postoperatively, 10/11 cases achieved normal cardiac function.

CONCLUSIONS

Echocardiography provides a clinically actionable protocol for preoperative AAOCA diagnosis by integrating anatomical markers (Acute deviation, parallel course) and functional metrics (LVEF, wall motion). This approach enables early identification of high-risk cases (e.g., ALCA with severe systolic dysfunction) and guides timely intervention, reducing reliance on radiation-based imaging in children. Despite limited sample size, the proposed framework addresses a critical gap in pediatric-specific AAOCA management.