title: Two-dimensional and Doppler transesophageal echocardiographic delineation and flow characterization of anomalous coronary arteries in adults.
abstract: OBJECTIVE
  The purpose of this study was to examine the use of transesophageal echocardiography (TEE) in the identification and flow characterization of congenital coronary anomalies.
  
  
  BACKGROUND
  Congenital coronary anomalies in adults are rare but may cause serious cardiac complications. The use of TEE in evaluation of this entity has not been well defined. Very little is known regarding flow patterns in anomalous coronaries assessed by Doppler TEE.
  
  
  METHODS
  A total of 32 consecutive adult patients were studied using TEE to define the origin, course, and proximal flow pattern of suspected coronary anomalies.
  
  
  RESULTS
  Coronary anomalies identified using TEE included anomalous origin from the pulmonary trunk (n = 2), right sinus (n = 18), left sinus (n = 9), single coronary (n = 2), and left main coronary fistula (n = 1). Multiplane TEE performed in 20 cases simplified the delineation of more complex coronary anomalies. The origin was identified in all patients, proximal course delineated in 31, and proximal flow pattern characterized by pulsed Doppler in 23 of 32 patients. In 16 anomalous left main, left anterior descending, or left circumflex coronary arteries, an abnormal systolic flow pattern (ie, systolic/diastolic time-velocity integral ratio >1) occurred exclusively (P <.001) when the anomalous artery had an intermediate (100%; 5/5) versus anterior or posterior course (0%; 0/11) relative to the aortic and pulmonary artery trunks. A systolic flow pattern was also evident in 4 (80%) of 5 patients with an anomalous right coronary artery with an intermediate course.
  
  
  CONCLUSIONS
  TEE, particularly with a multiplane probe, has an important complementary role to coronary angiography in delineating the proximal course and pattern of flow in anomalous coronaries. Predominant systolic flow pattern in anatomically left proximal anomalous coronaries signifies an intermediate course between the aorta and the pulmonary trunk and may be clinically useful for risk stratification.
authors.affiliation: Department of Medicine, University of Louisville and Jewish Hospital Heart and Lung Institute, KY 40292, USA.
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.forename: J David
authors.initials: JD
authors.lastname: Talley
authors.forename: Charles R
authors.initials: CR
authors.lastname: Prince
authors.forename: Azizul
authors.initials: A
authors.lastname: Hoque
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Morris
authors.forename: Nicholaos P
authors.initials: NP
authors.lastname: Xenopoulos
authors.forename: Marcus F
authors.initials: MF
authors.lastname: Stoddard
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology; D015150:Echocardiography, Doppler; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow