Intercoronary blood flow detected by color flow Doppler mapping is a well-known marker for anomalous origin of a coronary artery from the pulmonary trunk
Abstrakt
I read with interest the article by Frommelt et al titled "Detection of septal coronary collaterals by color flow Doppler mapping is a marker for anomalous origin of coronary artery from the pulmonary artery." However, I have a few issues with the report. First, the septal turbulent flow represents increased blood flow through collateral vessels between 2 coronary arteries.
This phenomenon detected by color flow Doppler mapping was first reported in 1990 for the anomalous origin of the left coronary artery from pulmonary trunk and in 1994 for the anomalous origin of the right coronary artery (RCA) from the pulmonary trunk. Similarly, Salzer-Muhar et al detected this intercoronary flow by Doppler echocardiography in 3 patients.
Thus, the color Doppler detection of intercoronary collateral flow as a marker of anomalous origin of coronary artery from pulmonary artery was established in the early '90s. Second, I believe that all patients with anomalous origin of the RCA from pulmonary trunk require surgical treatment.
Mintz et al were first to prove coronary arterial steal from the left coronary artery by collateral vessels into the anomalous RCA and the pulmonary artery using myocardial perfusion scintigraphy by intracoronary injection of radiolabelled albumin microspheres. They found a 5:1 resting left-to-right shunt through the collateral vessels in the coronary vascular bed.
Moreover, there is a strong clinical evidence for episodes of myocardial ischemia, myocardial infarction, and sudden death associated with this anomaly. Because of concern for a potentially adverse outcome, surgical correction of this anomaly is generally recommended.
The only question remains whether the technically more difficult restoration of a 2-coronary artery system by direct reimplantation of the RCA into the aorta is superior to simple ligation of RCA.