ANOMALOUS ORIGIN OF THE CIRCUMFLEX CORONARY ARTERY FROM THE RIGHT CORONARY SINUS OF VALSALVA: DIAGNOSIS AND COURSE; [АНОМАЛЬНОЕ ОТХОЖДЕНИЕ ОГИБАЮЩЕЙ КОРОНАРНОЙ АРТЕРИИ ОТ ПРАВОГО СИНУСА ВАЛЬСАЛЬВЫ У ДЕТЕЙ: ДИАГНОСТИКА И ТЕЧЕНИЕ]

Aim The aim of the study was to evaluate the effectiveness of transthoracic echocardiography (TTE) in case of anomalous origin of the circumflex coronary artery from the right coronary right sinus of Valsalva in children. Methods During a routine examination at the Department of Emergency Cardiac Surgery and Interventional Cardiology of the Morozov Children's City Clinical Hospital of Moscow from January 2022 to August 2023, anomalous origin of the circumflex coronary artery from the right coronary sinus was detected in 10 children. The criterion for the diagnosis of anomalous origin of the circumflex coronary artery from the right sinus of Valsalva were RAC and bleb signs on TTE. Results According to TTE, all 10 children have crossed aorta signs in apical five- and four-chamber projection in the form of a tubular image above the plane of the mitral valve. Only 2 patients undergoing TTE presented with the bleb sign. 7 children underwent coronary computed tomography angiography, and 5 of these patients presented with an anomalous origin of the circumflex coronary artery from the right sinus of Valsalva and 2 patients with an anomalous origin of the circumflex coronary artery from the proximal segment of the RCA. According to CT data, all 7 patients had a retroaortic course of the circumflex artery without signs of narrowing or compression, the angle of divergence in all cases was less than 45°. 3 patients underwent coronarography before the RFA, the data of the study confirmed the diagnosis as well. All 10 patients (100%) had negative bicycle stress echocardiogram results. TTE in experienced hands can provide valuable information about anomalies of the coronary arteries in children and thereby save time and reduce the cost of expensive diagnostic methods. Children with congenital heart defects and concomitant CA anomalies are at risk for coronary complications, since many of these patients are potential candidates for surgical intervention on the aortic valve/ root throughout life. Therefore, timely diagnosis of CA anomaly before surgery is crucial for understanding the spatial interaction between the retroaortic coarse of the CA and the valve/root of the aorta. Conclusion TTE is a cost-effective and non-invasive tool for screening patients that has a vital role in the diagnosis of anomalous origin of coronary arteries in children. Patients with an enlarged aortic root and a divergence of the circumflex artery from the right coronary sinus at an acute angle should be under the supervision of a cardiologist for timely prevention of cardiovascular complications. © 2024 NII KPSSZ. All rights reserved.