Zhen Cheng, Changbai Ding, Shanliang Zhu, Hao Liu, Yu Mao, Ying Tang, Chenshuang Zhou, Jun Chen
Nanjing Gaochun People’s Hospital. People’s Hospital of Pizhou. Children’s Hospital of Nanjing Medical University.
China
Journal of Clinical Ultrasound
J Clin Ultrasound 2026;
DOI: 10.1002/jcu.70352
Abstract
Objective: To evaluate the practical application of echocardiography in identifying anomalous left coronary artery from the pulmonary artery (ALCAPA) and to improve the precision of echocardiographic diagnosis for this specific condition.
Methods: We accomplished a retrospective review of 18 cases involving pediatric ALCAPA confirmed surgically, comparing preoperative echocardiographic findings with CT angiography (CTA) or surgical outcomes.
Results: Among the 18 pediatric patients, 15 were referred from external facilities, with 2 correct and 13 misdiagnoses by echocardiography. Misdiagnoses included 3 cases of dilated cardiomyopathy, 2 of endocardial fibroelastosis, 3 cases of mitral valve prolapse accompanied by regurgitation. At our institution, echocardiography achieved a correct diagnosis in 14 cases, yielding a diagnostic concordance rate of 77.7%. One case was missed, and 3 were misdiagnosed, with 1 case missed because of coexisting pulmonary hypertension and ventricular septal defect. Among the misdiagnosed cases, 1 was misdiagnosed as multiple trabecular muscular ventricular septal defects with mitral valve anterior leaflet prolapse, 1 case was identified as an isolated abnormality of the mitral valve’s papillary muscle, 1 as dilated cardiomyopathy, resulting in a miss and misdiagnosis rate of 22.2%. Of the 13 cases misdiagnosed at external facilities, 3 were erroneously identified as partial anomalous pulmonary venous connection (PAPVC), with 2 of these displaying color Doppler flow patterns mimicking right pulmonary vein-to-superior vena cava drainage.
Conclusion: Echocardiography proves to be an invaluable diagnostic instrument for detecting ALCAPA, offering a basis for clinical management.
Category
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
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