A Suprasternal Approach to Assess the Proximal Coronary Arteries in Infants and Children

The authors propose a two-dimensional echocardiographic approach to demonstrate the origin and proximal course of the coronary arteries in children, which could be called "suprasternal right anterior oblique cut." The important feature disclosed by this new view, but not by the classic parasternal short-axis cut, is the spatial relationship between the origin of the coronary arteries, the aortic root, and the ascending aorta. The knowledge of this anatomical feature may be of surgical significance in the setting of congenital heart diseases, such as tetralogy and transposition, or acquired coronary diseases, such as Kawasaki's syndrome. The suprasternal right anterior oblique cut was obtained by rotating the transducer counterclockwise, with slight anterior tilting, from the classic long-axis view of the aorta, for imaging the left coronary artery. The left coronary artery arises as a main trunk from the upper portion, of the left coronary sinus, passes behind the pulmonary trunk and beneath the left atrial appendage for a few millimeters up to the point of bifurcation. Because of the orientation of the ultrasound beam, the left coronary is shown. between the right pulmonary artery and the left atrial appendage in this cut. To assess the right coronary artery, the transducer was slightly deviated to the right and further rotated counterclockwise, while very carefully tilted anteriorly. Fifty consecutive children (29 males, 21 females), with a mean. age of 5.4 +/- 4.1 years, were evaluated from May to July 1992, in. order to demonstrate the feasibility of the proposed approach. The left coronary artery was disclosed in 100% of cases, and the right in 76%. The 12 patients in which the right coronary artery was not visualized were significantly older than, the group in which both coronary arteries were demonstrated (P < 0.001). It was concluded that the suprasternal right anterior oblique two-dimensional echocardiographic cut for demonstration of the coronary arteries in, children is easy to perform, reproducible, and allows the assessment of anatomical features not disclosed by the classic approach.