Coronary Artery Program
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.
The team is always looking for innovative ways to diagnose and treat all types of coronary anomalies, and their research and innovations are helping guide them toward those goals.
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.
- Poynter JA, Williams WG, McIntyre S, Brothers JA, Jacobs ML and the Congenital Heart Surgeons Society AAOCA Working Group. Anomalous Aortic Origin of a Coronary Artery: A Report From the Congenital Heart Surgeons Society Registry. World Journal for Pediatric and Congenital Heart Surgery 2014 5: 22
- Lorber R, Srivastava S, Wilder TJ, McIntyre S, DeCampli W, MD, PHD, Williams WG, Frommelt PC, Parness IA, Blackstone EH, MD, Jacobs MJ, Mertens L, Brothers JA, Herlong JR, on behalf of the AAOCA Working Group of the Congenital Heart Surgeons Society Anomalous Aortic Origin of Coronary Arteries in the Young. J Am Coll Cardiol Img 2015; 8:1239–49
- Brothers JA, MD, Frommelt MA, MD, Jaquiss RDB, MD, Myerburg RJ, Fraser CD, Tweddell JS. Expert consensus guidelines: Anomalous aortic origin of a coronary artery. J Thorac Cardiovasc Surg 2017; 153:1440-57
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.