Coronary Artery Program

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The Boston Children’s Hospital Coronary Artery Program specializes in the assessment, diagnosis and treatment of coronary artery anomalies. Our goal is to provide patients and families with a comprehensive assessment and treatment plan for problems related to the coronary arteries. We also offer ongoing care and follow-up.

The coronary arteries provide blood supply to the heart. A coronary anomaly is an abnormal or malformed coronary artery. Anomalies of the coronary arteries may be congenital or acquired and may occur in children and adults. Conditions such as Kawasaki disease and homozygous familial hypercholesterolemia can affect the coronary arteries of children. Children born with anomalous aortic origin of the coronary artery (AAOCA), a type of congenital heart disease, may develop symptoms as teenagers or young adults. Coronary artery problems may also be associated with other types of congenital heart disease, such as transposition of the great arteries or Williams syndrome.

Luis Quinonez, MD, FRCS(C), serves as co-director for the Coronary Artery Program at Boston Children's Hospital.

Our expertise in coronary anomalies

The Coronary Artery Program team brings together experts from multiple specialties including Cardiology, Non-Invasive Cardiac Imaging, Cardiac Catheterization, Adult Congenital Heart, Cardiac Anesthesia and Cardiac Surgery to review cases, coordinate care, determine the best course of action and track outcomes. We draw on our years of experience to develop individualized treatment plans for each of our patients.

How we diagnose coronary artery anomalies

At Boston Children’s, we use advanced diagnostic modalities that allow us to detect and accurately diagnose coronary artery anomalies. Our world-class Division of Non-Invasive Cardiac Imaging is equipped with the latest state-of-the-art scanning technologies and is staffed by internationally-acclaimed experts.

Cardiac CT

Our cardiac CT lab is equipped with a third-generation dual-source scanner that enables our team to obtain high-quality coronary artery imaging, and can detect blockages in the coronary arteries in less than a second, while minimizing the exposure to x-rays. These images provide our cardiologists and surgeons with a roadmap that is used to plan catheter or surgical treatment. In some cases, we can avoid using invasive techniques such as cardiac catheterization for diagnosis alone, reserving them for interventional treatment.

Cardiac MRI

The Boston Children’s cardiac MRI laboratory is one of the largest of its kind in the world, equipped with a dedicated cardiac MRI scanner, full-time cardiac technologists and a full-time cardiac physicist. It is also staffed by leading experts in the field, and many of the cardiac MRI experts around the world have been trained at this program. Several noninvasive techniques are available for the structural and functional evaluation of coronary artery disorders. With MRI, we can image the coronary arteries without x-rays. We can also use MRI to assess the blood flow to the heart muscle when the heart is exerted with medication and detect old scars in the heart muscle.

Exercise stress echocardiogram

Boston Children’s is one of just a handful of pediatric hospitals in the U.S. with a dedicated exercise stress echocardiography (ESE) program. ESE is an echocardiogram performed immediately before and after a patient exercises on a treadmill or bicycle. While a resting echocardiogram can detail the anatomy and capture how the heart is functioning when the child is lying still, children are usually active and moving. An exercise stress echocardiography can show if there is enough blood flow getting to the heart when a child with a coronary anomaly is physically active.

Cardiac catheterization

Cardiac catheterization is another diagnostic tool we may use to investigate coronary artery problems. This minimally-invasive technique uses x-rays and dye injections through small catheters to take specialized pictures of the coronary arteries. In addition, doctors at Boston Children’s are using and testing new modalities of intravascular ultrasound and pressure wire transduction in children with unusual coronary artery problems, and are now beginning to apply them more generally. These techniques allow more precise localization and characterization of coronary narrowings, and give us information about their severity.

Our approach to treating coronary anomalies

At Boston Children’s, our Coronary Anomalies team will tailor treatment to you or your child’s unique condition. Options may include medical therapy, cardiac catheterization or surgery.

Medical therapy

Treatment with medications may be all that is required to treat some coronary artery anomalies. The types of medications used may vary and your cardiologist will discuss the options with you.

Cardiac catheterization

Catheter-based treatments for the coronary arteries include balloon angioplasty (stretching a narrowed vessel by blowing up a small balloon inside of it) or stent placement (implanting an expandable tube inside a narrowed vessel to keep it wide open). While these therapies are most often performed in adults, doctors at Boston Children’s have performed these procedures in infants and young children successfully. Adolescents and young adults with coronary artery diseases may be treated by catheterization at Boston Children’s, or may be referred for their procedures to our partner adult hospital. Coronary artery fistulas, or abnormal connections, can be closed with specially-designed devices in the catheterization laboratory.

Surgery

Because there are many different types of coronary artery anomalies, there may be a number of surgical options for any given condition. Your surgeon will discuss the options based on your child’s specific condition. For example, in patients where the coronary artery arises from pulmonary artery, we can detach the coronary artery from the pulmonary artery and reattach it, or translocate it, to the aorta. In patients where the coronary arteries arise abnormally, or anomalously, from the aorta and the coronary arteries run in the wall of the aorta, we can open up (unroof) the coronary artery as it runs through the wall to improve blood flow into it. When there are obstructions in the coronary artery along its course, we can perform coronary artery bypass grafting (similar to what is performed in adults). We have successfully performed coronary artery bypasses in very young children.

Boston Children’s is so much more than a hospital—it’s a community of researchers, clinicians, administrators, support staff, innovators, teachers, patients and families, all working together to make the impossible possible. ”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital
300 Longwood Avenue, Boston, MA 02115
For Patients: 617-355-6000
For Referring Providers: 844-BCH-PEDS | 844-224-7337

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