Two-dimensional echocardiographic differentiation of anomalous left coronary artery from congestive cardiomyopathy.

Infants having anomalous origin of the left coronary artery (ALCA) from the pulmonary artery may at times be difficult to distinguish clinically from those having a congestive cardiomyopathy (CCM). Five children having ALCA and 15 having CCM were studied by two-dimensional echocardiography (2DE) and angiography. The left coronary artery (LCA) was demonstrated by 2DE to arise normally in all children having CCM. The LCA aortic ostium was not recorded in any child with ALCA; however, the LCA was recorded in three patients. The 2DE recorded the LCA originating from the pulmonary artery in two of these infants. A prominent right coronary artery was seen in all patients with ALCA. Thus 2DE is helpful in distinguishing patients having ALCA from those with CCM.