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NON-INVASIVE DIAGNOSIS OF ANOMALOUS LEFT CORONARY ARTERY IN THE YOUNG WITH THALLIUM - 201 MYOCARDIAL IMAGING

The diagnosis of anomalous left coronary artery (ALCA) requires documentation by cardiac catheterization (CC) and angiocardiography (A). The electrocardiographic pattern of myocardial infarction may be atypical or absent; and other cardiomyopathies may have a similar clinical profile. This study was undertaken to assess the value of myocardial perfusion imaging in the diagnosis of ALCA.Three patients (pts.) with proven diagnosis of ALCA by CC and A, aged 0.7, 1 and 2 years respectively, received Thallium-201 I.V. ranging from 0.7 to 1.3 mCi. Scintigraphy revealed a defect in perfusion of the anterior wall (3/3 pts.) and apical region (2/3 pts.) of the left ventricle. Myocardial imaging in 2 children, ages 1.5 and 8 yrs., with severe cardiomyopathy of unknown origin with similar clinical profile to pts. with ALCA, had no abnormalities or diffuse and poorly defined distribution of the radionuclide in the myocardium.Thus, Thallium-201 myocardial imaging appears to be a promising non-invasive technique in the diagnosis of ALCA in the young and may prove of value in cases of high risk cardiac catheterization due to severe left ventricular dysfunction.