Objectives .– We sought to describe our experiment with major coronary anomalies (MCA) diagnosed in trans thoracic echocardiographic (TTE) in a large adult and pediatric population.

Background .– MCA may have serious clinical consequences. No echocardiographic study has identified prospectively all potentially serious coronary anomalies in a general adult and pediatric population.

Patients .– From June 2008 to January 2012, a systematic search for major coronary anomalies was conducted in children and adults patients, coming for a TTE.

Results .– Three thousand five hundred and two patients (84% adults and 16% children) received a TTE. Fourteen coronary anomalies (0.39%) were diagnosed: nine anomalous origins of coronary artery from the opposite sinus with inter arterial course, one abnormal left coronary artery from pulmonary artery, three single coronary arteries, one coronary fistula. Cardiac symptoms initiated investigation in seven patients. Five patients underwent specific surgery: two coronary reimplantations, three coronary bypass grafting. Ten patients had already received at least one TTE without the anomalous coronary artery being either diagnosed or suspected.

Conclusions .– MCA is a rare condition which can be identified through an accurate exploration of coronary anatomy by TTE. The search for potentially lethal congenital coronary anomalies should be included a standard echocardiographic examination.