The aim of this study was to explore the value of echocardiography in diagnosing anomalous origin of the coronary artery from the opposite sinus (ACAOS) and to summarize the high-risk anatomical features associated with intramural and non-intramural courses. A retrospective analysis was performed on echocardiograms of 24 patients with surgically confirmed ACAOS (median age 23.5 years; 12 males and 12 females) at Wuhan Union Hospital between May 2021 and January 2025. Patients were divided into intramural (n = 11) and non-intramural (n = 13) course subgroups. Parameters including take-off angle, thickness between the coronary artery and aortic intima, and proximal segment diameter were compared. Intramural courses were identified using “intra-ring sign,” and “thin-wall sign,” while non-intramural courses were characterized by “sandwich sign” and “extra-ring sign.” The initial recognition of intramural segments was 36.36%, leading to an overall diagnostic accuracy of 62.50%. After specialized training, diagnostic accuracy improved significantly to 87.50% (p = 0.031). Comparative analysis showed that the non-intramural subgroup had significantly greater intima-to-intima wall thickness (2.63 ± 0.13 mm vs. median 1.03 mm, p < 0.001) and larger take-off angle (34.51 ± 1.24° vs. 27.76 ± 0.58°, p = 0.025), while proximal segment diameter showed no significant difference (p = 0.119). This study proposes specific echocardiographic signs for diagnosing high-risk anatomical features in ACAOS. Specialized training significantly improves the detection rate of malignant coronary courses, enhancing the clinical utility of echocardiography.
Zhou et al. (Fri,) studied this question.