title: Echocardiographic diagnosis of clinically silent congenital coronary artery anomalies.
abstract: BACKGROUND
  The incidence of congenital coronary anomalies is mainly derived from autopsy series and pre-participation exams in athletes. Limited data exist regarding the spectrum of coronary anomalies that can be detected in asymptomatic patients. We sought to describe echocardiographically detected congenital coronary artery anomalies in asymptomatic children after implementing a screening protocol mandating identification of coronary artery origin and proximal course in all initial studies.
  
  
  METHODS
  Our database was searched from 1/1/1993 to 3/31/2006 and all echocardiograms coded for coronary anomalies were identified. Clinically "silent" congenital coronary anomalies were culled from that group.
  
  
  RESULTS
  Of the 168 "silent" coronary anomalies detected, 111 were anomalies of aortic origin, including 59 patients with "high coronary takeoff" and 30 patients with "wrong sinus" origin of either the left or right coronary artery. Small coronary fistulas were seen in 57. Associated congenital heart defects were found in 53% of individuals with coronary anomalies.
  
  
  CONCLUSIONS
  This study comprises the largest group of echocardiographically detected, "silent" but potentially clinically significant, congenital coronary anomalies in children. Prospective echocardiographic diagnosis of "high coronary takeoff", a risk factor for injury during cardio-pulmonary bypass, and asymptomatic intraseptal coronary stenosis are described for the first time.
authors.affiliation: Mount Sinai Medical Center, Department of Pediatrics, Division of Pediatric Cardiology, New York, NY 10029, USA.
authors.forename: Irene D
authors.initials: ID
authors.lastname: Lytrivi
authors.forename: Austin H
authors.initials: AH
authors.lastname: Wong
authors.forename: H Helen
authors.initials: HH
authors.lastname: Ko
authors.forename: Samir
authors.initials: S
authors.lastname: Chandra
authors.forename: James C
authors.initials: JC
authors.lastname: Nielsen
authors.forename: Shubhika
authors.initials: S
authors.lastname: Srivastava
authors.forename: Wyman W
authors.initials: WW
authors.lastname: Lai
authors.forename: Ira A
authors.initials: IA
authors.lastname: Parness
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate