OBJECTIVETo discuss the diagnostic methods and features of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).

METHODSA total of 22 cases of ALCAPA hospitalized between 2000 and 2007 were recruited and divided into infant group (age < or = 1 year, n = 10) and older children group (age > 1 year, n = 12). The patients' history, electrocardiography (ECG) and echocardiography were reviewed and analyzed retrospectively. ECGs were analyzed as follows: (1) Q wave and T wave inversion in lead I, (2) Abnormal Q wave and T wave inversion in lead aVL, (3) Q wave in lead V(5-6), (4) T wave inversion and ST changes in lead V(4-6), (5) LV hypertrophy. Echocardiograms were analyzed as follows: (1) Continuity of the left coronary artery (LCA) and pulmonary artery (PA), (2) Retrograde shunt into PA, (3) Increased papillary muscle echodensity, (4) Right coronary artery (RCA) dilation, (5) Collateral signals within the ventricular septum.

RESULTSThe presence of cardiomegaly in X-ray film (18/22), aVL QT pattern in ECG (17/22), retrograde color Doppler flow into pulmonary artery (20/22), anterior lateral papillary echogenic (17/22) and collateral vessel signals (16/22) in echocardiography were high in both groups (P > 0.05). The presence of clinical symptoms and abnormal Q wave in leads Iand V(5-6) in ECG were significantly higher in the infant group than in the older children group (P < 0.05). But the presence of right coronary artery dilation was significantly lower in the infant group than in the older children group (P < 0.05).

CONCLUSIONDifferent diagnostic features were found in infant and older children patients. With combination of patient history, electrocardiogram and echocardiogram, accurate diagnosis could be obtained in most pediatric patients with ALCAPA.