Imaging of congenital coronary artery anomalies

Abstract

Imaging of the coronary arteries is an important part of the evaluation of children with congenital heart disease and isolated congenital coronary artery anomalies. Echocardiography remains the main imaging modality and is complemented by MRI and CT angiography in the older or difficult-to-image child. We review echocardiography, MRI, and CT angiography for coronary artery imaging, with emphasis on techniques. The clinical implications of isolated congenital coronary artery anomalies are also addressed, along with a discussion about the current consensus on optimal management of these anomalies.

Application of prospective ECG-triggered dual-source CT coronary angiography for infants and children with coronary artery aneurysms due to Kawasaki disease

“…The findings were confirmed by both retrospective and prospective ECG-triggered CT angiography in children and infants with coronary artery deformities [2, 5, 7, 9, 12, 15-17, 20, 41]. A prospective ECG-triggered protocol was supposed to be as good as that of XCA [15,16,41]. However, ionising radiation is the inherent drawback of a CT scan.…”

“…Moreover, a low heart rate (ideally ,100 bpm) and a regular heart beat interval are needed. In our study, the mean heart rate was 112 bpm, at which it is hard to acquire diagnostic images using MRA [33,38].…”

“…However, because of the higher radiation dose, invasiveness, higher contrast material dose, the need for hospitalisation and potential complications (haematomas, dissections, vascular rupture, arrhythmias and death) [35,36] the diagnostic role of XCA has largely been replaced by other advanced noninvasive imaging tools [33,37]. MR angiography (MRA) has shown promise for visualisation of coronary arteries in children [33].…”

“…So it is important to carry out a thorough assessment of the whole coronary artery, including the distal coronary artery. TTE is the main imaging modality in children to evaluate proximal coronary artery disease and direction of flow [32,33]. However, visualisation of the distal coronary artery segments using TTE is limited owing to deterioration of the acoustic window [20,33,34].…”

Third-generation dual-source 70-kVp chest CT angiography with advanced iterative reconstruction in young children: image quality and radiation dose reduction

“…Multi-detector computed tomography (MDCT) is widely used for pre-and postoperative evaluation of thoracic and cardiovascular diseases in children [1][2][3][4][5]. The total number of examinations increased within the last years because of its wide availability, the short duration of the procedure and corresponding reduced need for sedation compared to MRI, and the availability of three-dimensional isovolumetric datasets [6,7].…”