Scientific Session 25 — Cardiac - CoronaryThursday, May 4, 2017
3028. Diagnostic Performance of CT Angiography for Coronary Artery Anomalies in Congenital Heart Disease
Diaz-Zamudio M1*, Magaña-Leon J1, Jimenez-Santos M1, Dosal-Bañuelos J2, Criales-Vera S1 1. Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico; 2. Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
Address correspondence to M. Diaz-Zamudio (firstname.lastname@example.org)
Objective: The prevalence of coronary artery anomalies in congenital heart disease (CHD) is higher than in the general population. Presurgical accurate coronary anatomy evaluation is recommended to secure a successful procedure. The objective of this study was to describe the prevalence of coronary artery anomalies in a pediatric population with CHD using dual-source CT.
Materials and Methods: We included consecutive pediatric patients referred to our department for CHD evaluation from January 2014 to August 2015. We excluded all patients with surgery involving reimplantation of coronary arteries. A 256-MDCT scanner was used. A high-pitch non–ECG-gated or prospective ECG-gated protocol was performed according to the clinical indication and criteria determined by experts in cardiovascular imaging. No sedation was used. For analysis, patients with CHD were divided in two groups: noncomplex CHD and complex CHD. Noncomplex CHD was defined as one or two cardiac defects with potential correction during a single procedure, and complex CHD was defined as multiple cardiac defects susceptible to palliative or progressive corrective surgeries requiring follow-up.
Results: Our study included 635 patients. Mean age was 6.09 years (range, 1 day–22 years), 346 (54.5%) were boys. Mean radiation dose ± SD was 1.85 ± 2.13 mSv; mean dose-length product was 107 ± 102.7 mGy × cm. Complex CHD was identified in 279 (43.9%) patients. Coronary arteries were evaluated in 612 (96.4%) cases. The percentage of patients with coronary arteries that could not be evaluated was higher in patients with complex CHD (5.7% vs 1.9%, p = 0.012), in younger patients (< 1 month, 19%; 1–6 months, 8.2%; 6 months–3 years, 3.97%; 3–5 years, 2.78%; and > 5 years, 1.57%; p < 0.0001), and in those with lower weight (mean weight for patients with evaluated vs unevaluated coronary arteries, 20.4 vs 11.2 kg; p = 0.009). There was no significant difference in radiation dose in patients with evaluated versus unevaluated coronary arteries (1.87 vs 1.14 mSv, p = 0.11). Coronary anomalies were diagnosed in 133 (20.9%) patients. The right coronary artery was more frequently involved in both origin and course anomalies. We identified a single coronary artery in 13 (2%) patients and an anomalous left coronary artery from pulmonary artery defect in three patients (0.47%). Coronary anomalies were associated with complex CHD in 104/279 (37.3%) patients and noncomplex CHD in 29/356 patients (8.2%, p < 0.0001). Malignant coronary anomalies were identified in 24 patients (8.6%) with complex CHD and in nine patients (2.5%) with noncomplex CHD.
Conclusion: The current state of CT provides an accurate, noninvasive alternative for the evaluation of coronary artery anatomy in children with CHD thanks to its excellent spatial orientation and spatial resolution. Coronary artery anomalies are more prevalent in patients with complex CHD.