Diagnosis of Anomalous Origin of Left Coronary Artery from Pulmonary Artery by Comprehensive Echocardiography

Two-dimensional and Doppler echocardiographic examination of the coronary arteries in pediatric patients with congenital or acquired lesions is well e~tablished.l-~ Diagnosis of anomalous origin of the left coronary artery from the pulmonary artery by use of two-dimensional echocardiography has also been reported.6 False-positive and false-negative diagnoses of this anomaly have been described, however, when using two-dimensional echocardiography alone.' Pulsed-Doppler ultrasound recently has been combined with two-dimensional echocardiography to confirm the diagnosis of this lesion.*" Recognition of this congenital malformation is of major clinical importance because it is amenable to surgical treatment.le14 If not diagnosed and treated early, the lesion has a serious prognosis, with a mortality of about 80% in infan~y.''J'-~~ In this report, we demonstrate the use of pulsedand color flow Doppler, in conjunction with two-dimensional echocardiography, as a comprehensive noninvasive technique for the diagnosis and precise localization of anomalous origin of the left coronary artery from the pulmonary artery in two children. The diagnosis was confirmed by use of cardiac catheterization and angiography.