title: Cardiac MRI and CT: differentiation of normal ostium and intraseptal course from slitlike ostium and interarterial course in anomalous left coronary artery in children.
abstract: OBJECTIVE
  Anomalous left coronary artery from the inappropriate aortic sinus with intraseptal course is generally benign but can be confused on imaging studies with the potentially lethal interarterial, intramural anomalous left coronary artery. The purpose of this study was to assess normal ostial morphologic features and intraseptal course using cardiac MRI and CT in pediatric patients with intraseptal anomalous left coronary artery.
  
  
  METHODS
  A retrospective review was conducted of the medical records of 14 children with the diagnosis of intraseptal anomalous left coronary artery between November 2009 and March 2013. Coronary artery origin and course were evaluated with cardiac MRI or CT, and 3D assessment of coronary ostial morphologic features was performed with virtual angioscopy.
  
  
  RESULTS
  The patient ages ranged from 5 to 18 years at diagnosis; 10 (71.4%) were boys. The right and left coronary origins were the right sinus of Valsalva as a common origin (n = 9) or a single coronary artery (n = 5). Anomalous intraseptal left main coronary was found in 13 patients, and one patient had anomalous left anterior descending with retroaortic circumflex coronary artery. Anomalous coronary ostia were round and without stenosis in all studies. The anomalous vessel was identified with echocardiography, but the anomalous left coronary artery was not delineated, and a normal ostium was not adequately portrayed in any instance.
  
  
  CONCLUSIONS
  By use of cardiac MRI and CT, the anomalous course of round coronary ostia was confirmed and visualized in a pediatric cohort with intraseptal anomalous left coronary artery. The data provide the basis for understanding the benign clinical course and showing that surgery is unnecessary for this coronary anomaly.
authors.affiliation: 1 Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Blvd, 8th Fl, Philadelphia, PA 19104.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Brothers
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Whitehead
authors.forename: Marc S
authors.initials: MS
authors.lastname: Keller
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fogel
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Paridon
authors.forename: Paul M
authors.initials: PM
authors.lastname: Weinberg
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000175:diagnosis*; D003331:Coronary Vessels / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT; MRI; anomalous aortic origin of the coronary artery (AAOCA); anomalous coronary artery; congenital heart defects; pediatrics