Assessment of Anomalous Coronary Arteries by Imagers and Surgeons: Comparison of Imaging Modalities

Kanwal M. Farooqi, Shannon N. Nees, Jennifer Smerling, Sri H. Senapathi, Raymond Lorenzoni, Martina Pavlicova, Andrew J. Einstein, Emile A. Bacha, David Kalfa, Paul J. Chai

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Anomalous aortic origin of a coronary artery (AAOCA) is associated with sudden cardiac death. High-risk characteristics are most commonly assessed using a 2-dimensional (2D) echocardiogram (echo) or cardiac computed tomography (CT). We hypothesize that these characteristics will be more accurately assessed when they are presented in the form of a 3D digital model. Methods: Fourteen participants, including cardiothoracic surgeons and cardiac imaging specialists, assessed image representations, including echo, CT images, and a 3D digital model, from 6 patients who had undergone AAOCA repair. Accuracy of assessment was evaluated by comparing responses with operative findings (the gold standard). Results: The reported type of AAOCA was most accurately assessed on CT (100%) and 3D models (92.31%) compared with echo (80.77%). The accuracy of the AAOCA course was highest on CT (91.03%), followed by the 3D model (80.77%), and lowest on echo (61.54%). The accuracy of intramurality was low across all imaging modalities (17.95% echo, 29.49% CT, and 21.79% 3D model). Accurate assessment of a separate AAOCA ostium was highest on 3D models (97.40%). Ostial stenosis was more accurately assessed on 3D models (56.41%). When accuracy was separated by subspecialty, CT and 3D models were more accurately assessed by all participants regardless of training. Conclusions: Cardiac imagers and congenital cardiothoracic surgeons most accurately assessed AAOCA presence, type, and course on cardiac CT and 3D models. 3D models were superior in representation of ostial characteristics. CT and 3D models are overall more accurately assessed by specialists regardless of training.

Original languageEnglish
Pages (from-to)672-681
Number of pages10
JournalAnnals of Thoracic Surgery
Issue number2
StatePublished - Feb 2021
Externally publishedYes


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