Congenital Anomalies of the Coronary Arteries

This chapter reviews the imaging of coronary artery anomalies of importance to the pediatric cardiologist with a focus on echocardiography. Embryologic development of the coronary arteries extends from the endocardial sinuses to the epicardial network. There are normally two major coronary arteries, which originate from aortic sinuses that “face” the pulmonary artery - the right and left aortic sinuses of Valsalva. The coronary arteries provide a flow of oxygenated blood to the almost exclusively aerobic myocardium, and a delicate balance is maintained between myocardial oxygen supply and demand. Two-dimensional echocardiography with color Doppler is an established tool in the diagnosis and functional evaluation of infants and children with suspected anomalies of the coronary arteries. Anomalies of coronary arteries are important in numerous types of congenital heart disease. The chapter reviews multimodality and perfusion imaging, and the contributions of computed tomography/angiography for prevalence studies.