Program Spotlight

Coronary Artery Program

The Boston Children’s Hospital Coronary Artery Program specializes in the assessment, diagnosis and treatment of coronary artery anomalies. With the goal of providing patients and families with a comprehensive assessment and treatment plan for congenital or acquired problems related to the coronary arteries, the program’s patients include those with conditions such as anomalous aortic origin of the coronary artery (AAOCA), Kawasaki disease, homozygous familial hypercholesterolemia, transposition of the great arteries and Williams syndrome.

The Coronary Artery team reviews a case.

Depth of expertise

Led by co-directors Jane Newburger, MD, MPH, Associate Cardiologist-in-Chief, and Luis Quinonez, MD, FRCS(C), assistant in cardiac surgery, the Coronary Artery Program 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. The team draws on many years of experience to develop individualized treatment plans for each of our patients. 

Coronary artery anomaly diagnostics

Advanced diagnostic modalities are used to detect and accurately diagnose coronary artery anomalies. The Division Cardiac Imaging is equipped with the latest state-of-the-art scanning technologies and is staffed by internationally-acclaimed experts. The cardiac CT lab is equipped with a third-generation dual-source scanner that enables the team to obtain high-quality coronary artery imaging, and can detect blockages in the coronary arteries in less than a second, while minimizing radiation exposure.

The Boston Children’s cardiac MRI laboratory is one of the largest of its kind in the world. Several noninvasive techniques are available for the structural and functional evaluation of coronary artery disorders. High-resolution coronary angiography can be performed with or without the use of contrast material or radiation. Functional assessment of the coronary circulation can also be performed, when necessary, using a dobutamine stress MRI. In addition, the presence of scar tissue in the heart muscle can be assessed using late gadolinium enhancement techniques.

Boston Children’s is one of just a handful of pediatric hospitals in the U.S. with a dedicated exercise stress echocardiography (ESE) program. 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 is another diagnostic tool that may be used to investigate coronary artery problems. The Coronary Artery Program is also using and testing new modalities of intravascular ultrasound and pressure wire transduction in children with unusual coronary artery problems, and is now beginning to apply them more generally. These techniques allow more precise localization and characterization of coronary stenoses, and provide information about their severity.

Leading-edge research

The team is always looking for innovative ways to diagnose and treat all types of coronary anomalies. Our research and innovations are helping guide diagnosis and therapy. Our research reflects our experience and expertise with conditions such as AAOCA, Kawasaki disease and surgical treatment for coronary anomalies

Recent research includes:

  • Fabozza A, DiOrio M, Newburger JW, Powell AJ, Liu H, Fynn-Thompson FA, Sanders SP, Pigula FA, del Nido PJ, Nathan M. Anomalous Aortic origin of Coronary Arteries: A Single-Center Experience. Semin Thoracic Surg 2016; 28:791–800.
  • Son MBF, Gauvreau K, Kim S, Tang A, Dedeoglu F, Fulton DR, Lo MS, Baker AL, Sundel RP, Newburger JW. Predicting Coronary Artery Aneurysms in Kawasaki Disease at a North American Center: An Assessment of Baseline z Scores. J Am Heart Assoc. 2017 May 31; 6(6). PubMed PMID: 28566299.
  • Friedman KG, Gauvreau K, Hamaoka-Okamoto A, Tang A, Berry E, Tremoulet AH, Mahavadi VS, Baker A, deFerranti SD, Fulton DR, Burns JC, Newburger JW. Coronary Artery Aneurysms in Kawasaki Disease: Risk Factors for Progressive Disease and Adverse Cardiac Events in the US Population. J Am Heart Assoc. 2016 Sep 15; 5(9). PubMed PMID: 27633390.
  • Ronai C, Hamaoka-Okamoto A, Baker AL, de Ferranti SD, Colan SD, Newburger JW, Friedman KG. Coronary Artery Aneurysm Measurement and Z Score Variability in Kawasaki Disease. J Am Soc Echocardiogr. 2016 Feb; 29(2): 150-7. Epub 2015 Sep 19. PubMed PMID: 26386984.
  • Scheule AM, Zurakowski D, Blume ED, Stamm C, del Nido PJ, Mayer JE Jr, JonasRA. Arterial switch operation with a single coronary artery. J Thorac Cardiovasc Surg. 2002 Jun; 123(6): 1164-72. PubMed PMID: 12063464.

Approach to treating coronary anomalies

The team tailors treatment to each child’s unique condition. Medical management may be all that is required to treat some coronary artery anomalies. For others, catheter-based treatments or surgery may be recommended.

Catheter-based treatments for the coronary arteries include balloon angioplasty or stent placement. While these therapies are most often performed in adults, Boston Children’s clinicians have experience performing these procedures in infants and young children successfully.

Because there are many different types of coronary artery anomalies, there may be a number of surgical options for any given condition. In patients where the coronary artery arises from pulmonary artery, they 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 anomalously, from the aorta and the coronary arteries run in the wall of the aorta, they can 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, they can perform coronary artery bypass grafting (similar to what is performed in adults). They have successfully performed coronary artery bypass in very young children.