Evaluation & Testing

ECG

There has been an increase in the number of children and adolescents diagnosed with AAOCA after routine physical exams prior to sports participation due to the presence of a heart murmur or an abnormal electrocardiogram (ECG). One of the first tests your child will have is an ECG. This tells your medical team about the electrical activity of the patient’s heart. An ECG is performed at nearly every cardiology visit.


Echocardiogram

Typically, an echocardiogram is performed when there is initial concern for a possible cardiac condition and the diagnosis of AAOCA is suspected.  The echocardiogram is an ultrasound of your child’s heart. Your child may have already had an echocardiogram, and was subsequently referred to the CAAP for concerns of anomalous coronary artery. The echocardiogram is usually done during the first visit. If your child has a surgical intervention, then the test will be repeated after surgery as well.


CTA

Clinicians typically use computerized tomographic angiography (CTA) to image the heart and coronary arteries, the preferred method at Texas Children’s, given its precision of details, but other institutions may choose to use cardiac magnetic resonance imaging (CMRI).

Advantages

Disadvantages

CMRI

  • Evaluates the heart function.
  • Evaluates the blood flow to the heart muscle.
  • No radiation exposure.
  • Some children require sedation.
  • Unable to adequately evaluate the ostium (opening of the coronary artery in the aortic sinus).
  • Unable to accurately evaluate for and measure interarterial and intramural course.
  • Unable to evaluate coronary artery diameter during varying phases of the cardiac cycle.

CTA

  • Reduced radiation exposure by 60-90% with high-definition new scanners.
  • Usually no sedation required.
  • Accurately evaluates the ostium.
  • Defines with precision for interarterial and intramural course.
  • Able to evaluate coronary artery diameter during varying phases of the cardiac cycle.
  • Some radiation exposure, but is limited with high-definition new scanners.  

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The CTA is a quick scan of your child’s chest to look at the heart and coronary artery anatomy in more detail and can identify AAOCA. The CTA usually does not require sedation, but may be necessary in rare cases. The scan is usually completed in 5-10 minutes. The CTA shows your medical team detailed images of the coronary arteries.

The image to the right is a clip of a CTA that shows an AAOLCA. The coronary artery is much lighter than the heart muscle. As you can see, the left coronary artery is located close the right coronary artery and is narrowed.

Intravenous (IV) catheter: An IV is a tiny straw that is used to give the body medicine. Your child will need an IV for contrast medication. Your child might feel a pinch or a poke as it goes in the vein. We have ways to manage any pain associated with this procedure.

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Preparing For Your CT Scan

Begin talking to your child about this experience 2-4 days prior to the appointment. Be age appropriate and honest, using simple terms like: “We are going to the hospital to take pictures of your body.” It may be helpful to watch the video about the procedure to the left.


Exercise Stress Test

The evaluation process at our CAAP includes functional assessment of the heart muscle upon exercise to study adequacy of blood supply to the cardiac muscle (at rest as well as during induced stress). The exercise stress test is done with your child running on the treadmill with an ECG and face mask applied. The test informs your clinician about any abnormal waveforms or beats or abnormal oxygen consumption that would be concerning for ischemia.

For more information about Exercise Stress Test, click here.


Cardiac stress MRI (sCMR)
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The sCMR uses medications to stimulate responses in the heart that occur during exercise. The sCMR looks for low blood flow or no blood flow to any part of the heart muscle. Medication is given during the stress MRI to help the heart beat faster, to mimic exercise.

For more information about sCMR, click here.


Cardiac Catheterization
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In some coronary anomaly cases, further evaluation is necessary to evaluate the blood flow of the anomalous coronary artery. This is typically needed in patients with AAOCA that involve an intraseptal course, as well as others. Cardiac cath is typically an outpatient procedure, allowing the child to go home the same day. There are some cases in which further monitoring is necessary, involving an overnight stay in the hospital.

For more information regarding cardiac catheterization, click here.