title: Utility of Multimodality Imaging in the Morphologic Characterization of Anomalous Aortic Origin of a Coronary Artery.
abstract: Anomalous aortic origin of a coronary artery from the wrong Sinus of Valsalva (AAOCA) is a rare congenital anomaly and is associated with sudden cardiac death. Morphologic features considered to be "high risk" are significant luminal narrowing, acute coronary angulation at its origin, intramural course, and long interarterial course. A consistent approach for characterization of these features is lacking.
  
  
  
  A retrospective single-center review of all patients diagnosed with AAOCA using echocardiogram and computed tomography (CT)/magnetic resonance imaging (MRI) studies was performed. Twenty-nine patients were identified (25 using CT and 4 using MRI) with subsequent three-dimensional data sets. The MRI data sets lacked adequate resolution and were excluded. Twenty-five patients (median age 15.1, range 10-39.5 years, 72% male) were further analyzed using echocardiogram and CT. Morphologic assessment focused on luminal stenosis, coronary angulation, and interarterial length. Additional morphologic features focusing on cross-sectional area and degree of ellipticity were also assessed.
  
  
  
  Echocardiography tended to yield smaller measurements compared to CT and had poor interobserver reproducibility for measurements pertaining to the narrowest proximal and distal coronary segments. Computed tomography showed good inter-/intraobserver reproducibility for the same. Agreement between both modalities for coronary angulation at its origin was excellent. There was good agreement for measurements of interarterial length between echocardiography and CT, but echocardiography had superior reproducibility. Assessment of luminal cross-sectional area and elliptical shape by CT had excellent inter-/intraobserver reproducibility.
  
  
  
  The combination of echocardiography and CT characterizes morphologic features of anomalous origin of the coronary artery more reliably than either modality alone.
authors.affiliation: Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA simon.lee@mssm.edu.
authors.forename: Simon
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Santosh C
authors.initials: SC
authors.lastname: Uppu
authors.affiliation: Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Irene D
authors.initials: ID
authors.lastname: Lytrivi
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Sanz
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of San Antonio, San Antonio, TX, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Weigand
authors.affiliation: Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Miwa K
authors.initials: MK
authors.lastname: Geiger
authors.affiliation: Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Rajesh U
authors.initials: RU
authors.lastname: Shenoy
authors.affiliation: Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Kanwal
authors.initials: K
authors.lastname: Farooqi
authors.affiliation: Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Khanh H
authors.initials: KH
authors.lastname: Nguyen
authors.affiliation: Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Ira A
authors.initials: IA
authors.lastname: Parness
authors.affiliation: Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Shubhika
authors.initials: S
authors.lastname: Srivastava
mesh_terms: D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D054079:Vascular Malformations / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: computed tomography; congenital heart disease; coronary artery anomaly; coronary imaging