Pediatric Coronary Anomalies

Congenital coronary artery anomalies are a rare class of congenital heart defects involving an abnormality of the origin and/or course of the coronary arteries, which are the blood vessels that supply the muscle of the heart.

The coronary arteries are small blood vessels that give blood supply to the heart itself. They normally arise from the very first part of the aorta, the main artery that delivers blood to the body. There are normally a left and right coronary artery and then the left coronary artery then divides into two arteries after it leaves the aorta. Anomalies of the coronary arteries are any arrangement of the coronary arteries that differs from the normal arrangement.

The coronary arteries can arise from an abnormal part of the aorta. Typically, the left coronary artery comes off the aorta close to the right coronary artery or vice versa. Because of multiple factors, this can lead to decrease blood flow to the heart muscle. This can lead to symptoms.

The coronary arteries can also arise from other abnormal locations. This can include the pulmonary artery, the main artery that gives blood from the heart to the lungs. The pressure in the pulmonary artery is lower than the aorta, so this coronary connection to the pulmonary artery can steal blood away from the heart and into the lung arteries.

In severe cases, these anomalous coronaries can cause the heart to weaken and make your child very sick. Decreased blood flow to the heart muscle can lead to the heart not functioning well, and it can eventually fail. If uncorrected, or corrected late, anomalous coronary arteries can lead to death.

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Patient with congenital coronary artery anomalies may be asymptomatic, and some may have symptoms, including:

• Chest pain
• Loss of consciousness
• Palpitations
• Dizziness with exercise

The initial evaluation of the coronary artery anomaly starts with an electrocardiogram, a machine records the electrical activity of your heart with a pen and graph paper, and transthoracic echocardiography, a still or moving image of the internal parts of the heart using ultrasound. The affiliated team at the Children’s Heart Institute at Children’s Memorial Hermann Hospital may ask you to send any previous medical records from outside facilities before your scheduled clinic visit. This helps our team review the records before the first clinic visit.

Coronary artery anomaly evaluation may also involve advanced imaging with cardiac computed tomography (CT) for better visualization of the coronary arteries and cardiac magnetic resonance imaging (MRI) to evaluate the blood flow to the heart muscles and to assess for any scar in the heart muscle. Once the diagnosis is confirmed, patients may need exercise stress test to evaluate the impact of coronary artery blood flow during activity.

Once all the testing is completed, we will discuss the coronary artery anomaly diagnosis and what it means for your child and your family as well as outline potential management options based on the most up-to-date information.

Depending on the information we have at the time of your visit, we may ask you to return for a follow-up visit in 1 to 2 months in order to allow for review of all the information with the entire team and for the development of the best management strategy. Once the best management strategy is formulated, you will be contacted by one of our team members to discuss the plan of care.

At Children’s Heart Institute at Children’s Memorial Hermann Hospital, patients with congenital or acquired heart disorders receive hands-on specialized care 24/7 from a team of affiliated physicians and specialty-trained nurses who aim to deliver the best possible outcomes.

Children’s Memorial Hermann Hospital was named one of the top children's hospitals nationally in Cardiology & Heart Surgery by U.S. News & World Report. In addition, Children’s Heart Institute is among the top congenital heart surgery programs in North America for patient care and outcomes, according to the Fall 2019 Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database Report of 118 STS participating programs.

In collaboration with various subspecialties, the affiliated team provides comprehensive care for newborns, children and adolescents, with the ability to transition into adult congenital cardiac care. Team members have the experience and skills necessary to offer innovative treatment methods and specialized services, including, but not limited to:

• Biventricular repairs and biventricular conversions
• Congenital heart optimization
• Full repairs for complex congenital heart defects in newborns
• Hybrid catheterization and surgical procedures
• Minimally invasive transcatheter pulmonary valve (TPV) therapy
• Minimally invasive repairs
• Treatment for adult congenital heart disease
• Valve repairs and preservation

With the Level IV Neonatal Intensive Care Unit (NICU) and a dedicated Children’s Heart Institute Intensive Care Unit at Children’s Memorial Hermann Hospital, critical heart patients have access to quality, specialized care. By utilizing state-of-the-art techniques, the team at Children’s Heart Institute strives to offer patients with the most complex problems the greatest opportunity for a normal life.

If you have any questions, use the online tool below to help us connect with you. To refer a patient or schedule an appointment, please contact our clinic using the information below.

• Pediatric Cardiology Clinic
  The University of Texas Health Science Center Professional Building
  6410 Fannin, Suite 370
  Houston, TX 77030
  Phone: (713) 486-6755 (Appointment Line)
   
• Pediatric and Congenital Heart Surgery Clinic
  The University of Texas Health Science Center Professional Building
  6410 Fannin, Suite 370
  Houston, TX 77030
  Phone: (713) 500-5746
  CMHH-Heart@memorialhermann.org

The Children’s Heart Institute is a collaboration between the affiliated physicians at McGovern Medical School at UTHealth Houston and Children’s Memorial Hermann Hospital. Typically, patients are seen on an outpatient basis at a UT Physicians clinic with all inpatient procedures performed at Children’s Memorial Hermann Hospital.