Demonstration of Coronary Arteries and Major Cardiac Vascular Structures in Congenital Heart Disease by Cardiac Multidetector Computed Tomography Angiography

Authors

  • Omer Faruk Dogan
  • Musturay Karcaaltincaba
  • Cem Yorgancioglu
  • Metin Demircin
  • Riza Dogan
  • Unsal Ersoy
  • Alpay Celiker
  • Dursun Alehan
  • Mithat Haliloglu
  • Erkmen Boke

DOI:

https://doi.org/10.1532/HSF98.20061013

Abstract

Background. Detection of coronary artery is important when considering surgical treatment of a congenital heart disease (CHD) such as tetralogy of Fallot (TF). Cardiac catheterization plays an important supplementary role in the evaluation of patients with CHD. In a few reports, it has been proposed that multidetector computed tomography (MDCT) can be helpful for the visualization of coronary arteries. We sought to demonstrate the feasibility and usefulness of MDCT angiography for anatomical evaluation of coronary arteries in CHD patients with suspected coronary artery anomalies.

Materials and Methods. A total of 10 patients, 9 pediatric and 1 adult, underwent MDCT angiography for the investigation of coronary artery anomalies and mediastinal vascular structures. Seven patients had TF; 5 of these patients were suspected of having coronary artery anomalies and 2 were suspected of having pulmonary artery atresia or a nonconfluent pulmonary artery. The other 3 patients had truncus arteriosus and severe left pulmonary artery stenosis (n = 1), double outlet right ventricle (n = 1), and Kawasaki disease (n = 1) with suspected coronary artery aneurysms. The entire heart, major vascular structures, and coronary artery anomalies were preoperatively scanned in patients with cyanotic heart disease. Examinations were performed by 16-MDCT with 1-mm slice thickness. A breath-holding test was performed in 5 patients. Nonionic iodinated contrast material (2 cc/kg) was administered by a power injector.

Results. Major vascular structures and the proximal part of the right and left coronary arteries were visualized successfully in all patients. Mid and/or distal segments of the coronary arteries were visualized in 5 patients with TF. Pulmonary vascular bed findings were also confirmed during surgery in patients with TF and in one patient with truncus arteriosus type I and severe left pulmonary artery stenosis. Kawasaki disease was diagnosed by the presence of aneurysms in one patient. Pulmonary artery atresia was confirmed in one patient and diameter of the pulmonary arteries (4 mm and 4.5 mm) was determined in the other 2 patients by MDCT.

Conclusion. The advantage of MDCT for cardiac imaging is the shortened scanning time for imaging the entire heart without long breath-holding times. Selective conventional coronary angiography is invasive and technically difficult in pediatric patients. We suggest that MDCT angiography can be performed as a noninvasive method in patients with CHD for the evaluation of coronary artery anatomy and anomalies and mediastinal vascular structures.

References

Berry BE, McGoon DC. 1973. Total correction of tetralogy of Fallot with anomalous coronary artery. Surgery 74:894-7.nBerry JM Jr, Einzig S, Krabill KA, Bass JL. 1988. Evaluation of coronary artery anatomy in patients with tetralogy of Fallot by two dimensional echocardiography. Circulation 78:149-56.nDabizzi RP, Gaprioli G, Aiazzi L, et al. 1980. Distribution and anomalies of coronary arteries in tetralogy of Fallot. Circulation 61:95-102.nFellows KE, Freed MD, Keane JF, Van Praagh R, Bernhard WF, Castenada AC. 1975. Results of preoperative coronary angiography in tetralogy of Fallot. Circulation 51:561-6.nFellows KE, Smith J, Keane JF. 1981. Preoperative coronary angiocardiography in infants with tetralogy of Fallot. Am J Cardiol 47:1279-85.nFernandes F, Alam M, Smith S, Khaja F. 1993. The role of transesophageal echocardiography in identifying anomalous coronary arteries. Circulation 88:2532-40.nFernandez-Valls M, Srichai MB, Stillman AE, White RD. 2004. Isolated left ventricular apical hypoplasia: a new congenital anomaly described with cardiac tomography. Heart 90:552-5.nFriedman S, Ash R, Klein D, Johnson J. 1960. Anomalous single coronary artery complicating ventriculotomy in a child with cyanotic congenital heart disease. Am Heart Journal 59:140-7.nGeorg C, Kopp A, Schroder S, et al. 2001. Optimizing image reconstruction timing for the R-R interval in imaging coronary arteries with multislice computerized tomography. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 173:536-41.nGianoccoro PJ, Sochowski RA, Morton BC, Khan KL. 1993. Complementary role of transesophageal echocardiography to coronary angiography in the assessment of coronary artery anomalies. Br Heart J 70:70-4.nHerzog C, Ay M, Engelman K, et al. 2001. Visualization techniques in multislice computed tomography-coronary angiography of the heart. Correlation of axial, multiplanar, three dimensional and virtual endoscopic imaging with the invasive diagnosis. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 173:341-9.nHong C. 2004. Congenital coronary artery anomaly demonstrated by three dimensional 16 slice spiral CT. Heart 90:478.nHowe A, Rastelli GC, Ritter DG, Dushane JW, McGoon DC. 1970. Management of right ventricular outflow tract in severe tetralogy of Fallot. J Thorac Cardiovasc Surg 60:131-43.nJureidini SB, Appleton RS, Nouri S. 1989. Detection of coronary artery abnormalities in tetralogy of Fallot by two dimensional echocardiography. J Am Coll Cardiol 14:960-7.nLu B, Mao SS, Zhuang N, et al. 2001. Coronary artery motion during the cardiac cycle and optimal ECG triggering for coronary artery imaging. Invest Radiol 36:250-6.nMeng CC, Eckner FA, Lev M. 1965. Coronary artery distribution in tetralogy of Fallot. Arch Surg 90:363-6.nNieman K, van Ooijen P, Rensing B, Oudkerk M, de Feyter PJ. 2001. Four dimensional cardiac imaging with multislice computed tomography. Circulation 103:E62.nSones FM, Shirey EK, Proudfit WL, Wescott RN. 1959. Cine coronary arteriography. Circulation 20:773-5.nTaylor AM, Thorne SA, Rubens, et al. 2000. Coronary artery imaging in grown up congenital heart disease. Complementary role of magnetic resonance and x-ray coronary angiography. Circulation 101:1670-8.nVliegen HW, Doornbos J, deRoss A, Jukema JW, Bekedam MA, van der Wal EE. 1997. Value of fast gradient echo magnetic resonance angiography as an adjunct to coronary arteriography in detecting and confirming the course of clinically significant coronary artery anomalies. Am J Cardiol 79:773-6.nWestra SJ. 1996. Spiral and ultrafast computed tomography for noninvasive cardiac imaging in children. West J Med 165:55-6.nWhite RI, Frech RS, Castenada A, Amplatz K. 1972. The nature and significance of anomalous coronary arteries in tetralogy of Fallot. Am J Roentgenol Rad Ther Nucl Med 114:350.nZeppilli P, dello Russo S, Sentini C, et al. 1998. In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening. Chest 114:89-93.n

Published

2007-01-19

How to Cite

Dogan, O. F., Karcaaltincaba, M., Yorgancioglu, C., Demircin, M., Dogan, R., Ersoy, U., Celiker, A., Alehan, D., Haliloglu, M., & Boke, E. (2007). Demonstration of Coronary Arteries and Major Cardiac Vascular Structures in Congenital Heart Disease by Cardiac Multidetector Computed Tomography Angiography. The Heart Surgery Forum, 10(1), E90-E94. https://doi.org/10.1532/HSF98.20061013

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