Echocardiographic Analysis of Missed and Misdiagnosis in Children With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery.

OBJECTIVE

To evaluate the practical application of echocardiography in identifying anomalous left coronary artery from the pulmonary artery (ALCAPA) and to improve the precision of echocardiographic diagnosis for this specific condition.

METHODS

We accomplished a retrospective review of 18 cases involving pediatric ALCAPA confirmed surgically, comparing preoperative echocardiographic findings with CT angiography (CTA) or surgical outcomes.

RESULTS

Among the 18 pediatric patients, 15 were referred from external facilities, with 2 correct and 13 misdiagnoses by echocardiography. Misdiagnoses included 3 cases of dilated cardiomyopathy, 2 of endocardial fibroelastosis, 3 cases of mitral valve prolapse accompanied by regurgitation. At our institution, echocardiography achieved a correct diagnosis in 14 cases, yielding a diagnostic concordance rate of 77.7%. One case was missed, and 3 were misdiagnosed, with 1 case missed because of coexisting pulmonary hypertension and ventricular septal defect. Among the misdiagnosed cases, 1 was misdiagnosed as multiple trabecular muscular ventricular septal defects with mitral valve anterior leaflet prolapse, 1 case was identified as an isolated abnormality of the mitral valve's papillary muscle, 1 as dilated cardiomyopathy, resulting in a miss and misdiagnosis rate of 22.2%. Of the 13 cases misdiagnosed at external facilities, 3 were erroneously identified as partial anomalous pulmonary venous connection (PAPVC), with 2 of these displaying color Doppler flow patterns mimicking right pulmonary vein-to-superior vena cava drainage.

CONCLUSION

Echocardiography proves to be an invaluable diagnostic instrument for detecting ALCAPA, offering a basis for clinical management.