Congenital and acquired coronary artery disease in children: the challenging patients in paediatric practise

Abstract

Coronary artery disease (CAD) is a rare condition seen in the paediatric population, which makes it difficult to diagnose and manage these patients due to the broad spectrum of its clinicalforms that ranges from asymptomatic course to the development of sudden cardiac death syndrome as a result of myocardial ischemia in children. CAD presents as acquired and congenitalvariants with varying subtypes. Aim - to focus on aetiology, main clinical features, and early detection methods for CAD, prioritising children and adolescents to make it easier for the paediatric specialists to manage this challenging disease and prevent death. For this review, a totalof 50 articles have been analyzed from PubMed, Uptodate, Researchgate, Google Scholar, etc, which are taken from the past ten years ofjournals. CongenitalCAD presents as defects of origin, course, or termination, and anomalous origin of the left coronary artery from the pulmonary artery, also known as ALCAPA, has the highest prevalence, and it causes 90% deaths within the first year of life. When it comes to acquired CAD, the common aetiology is found to be Kawasaki disease, which is a type of medium vessel vasculitis predominant in children between 6 months and 8 years. Another in line is familialhypercholesterolemia. It is observed that patients aged from 11-23 years, who have a history of familial hyper¬cholesterolemia, 25% children and adolescents were found to have atherosclerotic plaques in the vessels that lead to myocardial ischemia and dysfunction. Accurate diagnosis requires specialized knowledge and skills using cardiac imaging methods. The «gold standard» method in this era is coronary computed tomography angiography, but it is not a routine test; therefore, doctors should educate themselves continuously with the latest updates in order to be able to determine the high-risk groups. Improved knowledge about coronary artery pathologies can be ofgreat help in diagnosing and managing children and help to prevent life-threa¬tening complications or sudden cardiac death.