Analysis of the missed and misdiagnosed echocardiographic diagnosis of anomalous left coronary artery originating from the pulmonary artery in children

WANG Yaping; CHEN Jun; SUN Lina; ZHU Shanliang; YANG Ming

doi:10.20258/j.cnki.1006-9011.2025.01.017

Abstract：Objective To investigate the clinical value of echocardiography in diagnosing children with anomalous left coro-nary artery originating from the pulmonary artery(ALCAPA),and to analyze the causes of the missed diagnosis and misdiagno-sis,with the aim of improving the accuracy of echocardiographic diagnosis of this disease.Methods We retrospectively ana-lyzed the clinical data of 18 cases with surgically confirmed ALCAPA in children,compared the sonographic manifestations of preoperative ultrasonography with the results of CTA or surgery,conducted an in-depth study of the missed and misdiagnosed so-nograms,and summarized the key points of echocardiographic diagnosis of this disease.Results Among the 18 children,15 cases were referred from outside hospitals,2 cases were correctly diagnosed by outside echocardiography,and 13 cases were mis-diagnosed.3 cases were misdiagnosed as dilated cardiomyopathy,3 cases were misdiagnosed as mitral valve prolapse with incom-plete closure,2 cases were misdiagnosed as endocardial elastosis,2 cases were misdiagnosed as multiple trabecular myocardial ventricular septal defects,2 cases were misdiagnosed as coronary right ventricular fistula,and 1 case was misdiagnosed as coro-nary pulmonary artery fistula.In our hospital,the echocardiographic diagnosis was correct in 14 cases,with a diagnostic compli-ance rate of 77.7%;one case was missed,three cases were misdiagnosed,and one case was missed because of the combination of ventricular septal defect and pulmonary hypertension at the same time.Among the three misdiagnosed cases,one case was mis-diagnosed as multiple trabecular muscle ventricular septal defects combined with mitral valve anterior leaflet prolapse,one case was misdiagnosed as mitral valve monopapillary malformation,and one case was misdiagnosed as dilated cardiomyopathy,with a miss-misdiagnosis rate of 22.2%.Conclusion Echocardiography has an important diagnostic value for ALCAPA and provides a diagnostic basis for clinical treatment.It is also important to analyze the causes of the missed and misdiagnosis to improve the di-agnostic accuracy of the disease,which has important clinical value for the timing and method of surgery and prognosis assess-ment of the children to avoid secondary surgery.