Reliability of echocardiography in the diagnosis of anomalous origin of the left coronary artery from the pulmonary trunk.

Previous studies have indicated that the definitive diagnosis of anomalous origin of the left coronary artery from the pulmonary trunk (ALC) should be made by cardiac catheterization and angiography. This study evaluates echocardiography (two-dimensional, pulsed Doppler, and color flow mapping) as a method to establish the diagnosis of ALC. To diagnose ALC, a modified parasternal short-axis view was used to demonstrate continuity of the ALC with the pulmonary trunk and to detect the retrograde flow through the ALC into the pulmonary trunk. Absence of these imaging characteristics ruled out ALC. From June 1985 to January 1990, 16 patients who presented with or had previously had a dilated poorly contracting left ventricle were prospectively assessed by echocardiography to rule out ALC. Four patients had ALC (age 2 to 120 months, mean +/- 1SD = 32 +/- 59) and 12 patients (age 1 to 192 months, mean +/- 1SD = 57 +/- 80) had myocardiopathy. Two other patients with known ALC were evaluated by an observer unaware of the diagnosis. All coronary anatomy was confirmed by angiography, surgery, or autopsy. The correct diagnosis of coronary anatomy was obtained by echocardiography in all instances without false positive or false negative diagnosis of ALC. Three infants underwent surgical repair of ALC based only on the echocardiographic diagnosis. Echocardiography can be used to establish the diagnosis of ALC. Therefore surgical repair can be undertaken in some critically sick infants based on the echocardiographic diagnosis alone.