THE ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN IDENTIFYING ANOMALOUSCORONARY-ARTERIES

Background. The study objective was to evaluate the role of transesoph ageal echocardiography in identifying the origin of anomalous coronary arteries and confirming their course in relation to the great vessels . The diagnosis of coronary anomalies is made by angiography. The anom alous left main artery with a course between the pulmonary artery and the aorta has been associated with myocardial infarction and sudden de ath. The course of these anomalous coronary arteries is difficult to d emonstrate by angiography alone. Methods and Results. Nine patients wi th angiographically confirmed anomalous coronary arteries were studied by transesophageal echocardiography with color flow Doppler. The abno rmal origin of the anomalous coronary arteries was confirmed by transe sophageal echocardiography in all nine patients. In four patients, the left main coronary artery originated from the right sinus of Valsalva . In all of these patients, transesophageal echocardiography demonstra ted the course of the anomalous left main coronary artery between the aorta and pulmonary artery better than angiography. Other anomalies th at were visualized included two patients with origin of the right coro nary arteries from the left aortic sinus, one patient with origin of t he left anterior descending from the right sinus, one patient with ori gin of circumflex from the right sinus, and one patient with origin of the left main coronary artery from the pulmonary artery. Conclusions. Transesophageal echocardiography is a useful noninvasive test for dia gnosing anomalous origin of the coronary arteries. Furthermore, it is a valuable adjunct to angiography in demonstrating the abnormal course of the left main coronary artery interposed between the aorta and the pulmonary artery, a potentially life-threatening entity.