Lee Yoon Jin, Park Kyoung Soo, Kil Hong Ryang
Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea.
Korean J Pediatr. 2019 Jun;62(6):240-243. doi: 10.3345/kjp.2018.07129. Epub 2018 Nov 22.
Coronary arterial lesion assessment in children can be difficult, depending on the coronary dominance pattern. Although it is easier to determine coronary dominance with echocardiography in children than in adults, it is still difficult. This study aimed to examine the coronary dominance pattern according to the objective coronary artery (CA) indices.
The CA diameter, aortic valve annulus, and abdominal aorta of 69 children without any cardiovascular disease were measured with cross-sectional echocardiography at Chungnam National University Hospital. To evaluate the coronary dominance pattern, echocardiography was primarily used; additionally, coronary computed tomographic angiography or coronary angiography (CAG). Coronary dominance was determined according to the status of the CA that gives rise to the posterior descending artery.
The mean age was 4.02±2.78 years, and the mean body surface area (BSA) was 0.70±0.22 m2 . Right dominance was present in 78% and left in 22% of the subjects. In those with left dominance, the CA to aortic valve annulus diameter ratio was 0.125±0.021 in the right coronary artery (RCA) and 0.255±0.032 in the left coronary artery (LCA). In those with right dominance, the corresponding ratio was 0.168±0.028 in the RCA and 0.216±0.030 in the LCA (P<0.05). Significant differences were also found in the diametric ratios of the CA to BSA and abdominal aorta (P<0.05).
The CA indices showed significant difference according to the coronary dominance pattern in early childhood. It is possible to indirectly determine the coronary dominance pattern with the CA indices in children using echocardiography. The accuracy of coronary artery lesion diagnosis can be improved by taking coronary dominance into account.
儿童冠状动脉病变评估可能具有挑战性，这取决于冠状动脉优势类型。虽然儿童通过超声心动图确定冠状动脉优势比成人更容易，但仍存在困难。本研究旨在根据客观冠状动脉（CA）指标检查冠状动脉优势类型。
在忠南国立大学医院，对69名无任何心血管疾病的儿童进行横断面超声心动图检查，测量其CA直径、主动脉瓣环和腹主动脉。为评估冠状动脉优势类型，主要使用超声心动图；此外，还采用冠状动脉计算机断层血管造影或冠状动脉造影（CAG）。根据发出后降支的CA情况确定冠状动脉优势。
平均年龄为4.02±2.78岁，平均体表面积（BSA）为0.70±0.22 m²。78%的受试者为右优势型，22%为左优势型。左优势型受试者中，右冠状动脉（RCA）的CA与主动脉瓣环直径比为0.125±0.021，左冠状动脉（LCA）为0.255±0.032。右优势型受试者中，RCA和LCA的相应比值分别为0.168±0.028和0.216±0.030（P<0.05）。CA与BSA和腹主动脉的直径比也存在显著差异（P<0.05）。
儿童早期CA指标根据冠状动脉优势类型显示出显著差异。利用超声心动图通过CA指标间接确定儿童冠状动脉优势类型是可行的。考虑冠状动脉优势可提高冠状动脉病变诊断的准确性。
