Echocardiographic Analysis of Missed and Misdiagnosis in Children With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

OBJECTIVE: To evaluate the practical application of echocardiography in identifying anomalous left coronary artery from the pulmonary artery (ALCAPA) and to improve the precision of echocardiographic diagnosis for this specific condition. METHODS: We accomplished a retrospective review of 18 cases involving pediatric ALCAPA confirmed surgically, comparing preoperative echocardiographic findings with CT angiography (CTA) or surgical outcomes. RESULTS: Among the 18 pediatric patients, 15 were referred from external facilities, with 2 correct and 13 misdiagnoses by echocardiography. Misdiagnoses included 3 cases of dilated cardiomyopathy, 2 of endocardial fibroelastosis, 3 cases of mitral valve prolapse accompanied by regurgitation. At our institution, echocardiography achieved a correct diagnosis in 14 cases, yielding a diagnostic concordance rate of 77.7%. One case was missed, and 3 were misdiagnosed, with 1 case missed because of coexisting pulmonary hypertension and ventricular septal defect. Among the misdiagnosed cases, 1 was misdiagnosed as multiple trabecular muscular ventricular septal defects with mitral valve anterior leaflet prolapse, 1 case was identified as an isolated abnormality of the mitral valve's papillary muscle, 1 as dilated cardiomyopathy, resulting in a miss and misdiagnosis rate of 22.2%. Of the 13 cases misdiagnosed at external facilities, 3 were erroneously identified as partial anomalous pulmonary venous connection (PAPVC), with 2 of these displaying color Doppler flow patterns mimicking right pulmonary vein-to-superior vena cava drainage. CONCLUSION: Echocardiography proves to be an invaluable diagnostic instrument for detecting ALCAPA, offering a basis for clinical management.