1
|
Moscatelli S, Pozza A, Leo I, Ielapi J, Scatteia A, Piana S, Cavaliere A, Reffo E, Di Salvo G. Importance of Cardiovascular Magnetic Resonance Applied to Congenital Heart Diseases in Pediatric Age: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:878. [PMID: 39062326 PMCID: PMC11276187 DOI: 10.3390/children11070878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/11/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Congenital heart diseases (CHDs) represent a heterogeneous group of congenital defects, with high prevalence worldwide. Non-invasive imaging is essential to guide medical and surgical planning, to follow the patient over time in the evolution of the disease, and to reveal potential complications of the chosen treatment. The application of cardiac magnetic resonance imaging (CMRI) in this population allows for obtaining detailed information on the defects without the necessity of ionizing radiations. This review emphasizes the central role of CMR in the overall assessment of CHDs, considering also the limitations and challenges of this imaging technique. CMR, with the application of two-dimensional (2D) and tri-dimensional (3D) steady-state free precession (SSFP), permits the obtaining of very detailed and accurate images about the cardiac anatomy, global function, and volumes' chambers, giving essential information in the intervention planning and optimal awareness of the postoperative anatomy. Nevertheless, CMR supplies tissue characterization, identifying the presence of fat, fibrosis, or oedema in the myocardial tissue. Using a contrast agent for angiography sequences or 2D/four-dimensional (4D) flows offers information about the vascular, valvular blood flow, and, in general, the cardiovascular system hemodynamics. Furthermore, 3D SSFP CMR acquisitions allow the identification of coronary artery abnormalities as an alternative to invasive angiography and cardiovascular computed tomography (CCT). However, CMR requires expertise in CHDs, and it can be contraindicated in patients with non-conditional devices. Furthermore, its relatively longer acquisition time and the necessity of breath-holding may limit its use, particularly in children under eight years old, sometimes requiring anesthesia. The purpose of this review is to elucidate the application of CMR during the pediatric age.
Collapse
Affiliation(s)
- Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | - Alice Pozza
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital of Padua, 35128 Padua, Italy (S.P.); (E.R.)
| | - Isabella Leo
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (I.L.); (J.I.)
| | - Jessica Ielapi
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (I.L.); (J.I.)
| | - Alessandra Scatteia
- Advanced Cardiovascular Imaging Unit, Clinica Villa dei Fiori, 80011 Acerra, Italy;
- Department of Medical, Motor and Wellness Sciences, University of Naples ‘Parthenope’, 80134 Naples, Italy
| | - Sofia Piana
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital of Padua, 35128 Padua, Italy (S.P.); (E.R.)
| | - Annachiara Cavaliere
- Pediatric Radiology, Neuroradiology Unit, University Hospital of Padua, 35128 Padua, Italy;
| | - Elena Reffo
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital of Padua, 35128 Padua, Italy (S.P.); (E.R.)
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital of Padua, 35128 Padua, Italy (S.P.); (E.R.)
| |
Collapse
|
2
|
Lau WR, Lee PT, Koh CH. Coronary Artery Anomalies - State of the Art Review. Curr Probl Cardiol 2023; 48:101935. [PMID: 37433414 DOI: 10.1016/j.cpcardiol.2023.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023]
Abstract
Coronary artery anomalies (CAAs) comprise a wide spectrum of anatomic entities, with diverse clinical phenotypes. We present a case of an anomalous right coronary artery arising from the left aortic sinus with an interarterial course, a potentially fatal condition that can precipitate ischemia and sudden cardiac death. CAAs are increasingly detected in adults, mostly as incidental findings in the course of cardiac evaluation. This is due to the expanding use of invasive and noninvasive cardiac imaging, usually in the work-up for possible CAD. The prognostic implications of CAAs in this group of patients remain unclear. In AAOCA patients, appropriate work-up with anatomical and functional imaging should be performed for risk stratification. An individualized approach to management should be adopted, considering symptoms, age, sporting activities and the presence of high-risk anatomical features and physiologic consequences (such as ischemia, myocardial fibrosis, or cardiac arrhythmias) detected on multimodality imaging or other functional cardiac investigations. This comprehensive and up to date review seeks to crystallize current data in the recent literature, and proposes a clinical management algorithm for the clinician faced with the conundrum of managing such conditions.
Collapse
Affiliation(s)
- Wei Ren Lau
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Phong Teck Lee
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore
| | - Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore; Changi Aviation Medical Centre, Changi General Hospital, Singapore.
| |
Collapse
|
3
|
Shen Q, Lin C, Yao Q, Wang J, Zhou J, He L, Chen G, Hu X. Addition of gadolinium contrast to three-dimensional SSFP MR sequences improves the visibility of coronary artery anatomy in young children. Front Pediatr 2023; 11:1159347. [PMID: 37215588 PMCID: PMC10196256 DOI: 10.3389/fped.2023.1159347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
Objective This study aims to compare the value of a gadolinium contrast-enhanced 1.5-T three-dimensional (3D) steady-state free precession (SSFP) sequence with that of a noncontrast 3D SSFP sequence for magnetic resonance coronary angiography in a pediatric population. Materials and methods Seventy-nine patients from 1 month to 18 years old participated in this study. A 3D SSFP coronary MRA at 1.5-T was applied before and after gadolinium-diethylenetriaminepentaaceticacid (DTPA) injection. The detection rates of coronary arteries and side branches were assessed by McNemar's χ2 test. The image quality, vessel length, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the coronary arteries were analyzed by the Wilcoxon signed-rank test. The intra- and interobserver agreements were evaluated with a weighted kappa test or an intraclass correlation efficient test. Results A contrast-enhanced scan detected more coronary arteries than a noncontrast-enhanced scan in patients under 2 years old (P < 0.05). The SSFP sequence with contrast media detected more coronary artery side branches in patients younger than 5 years (P < 0.05). The image quality of all the coronary arteries was better after the injection of gadolinium-DTPA in children younger than 2 years (P < 0.05) but not significantly improved in children older than 2 years (P > 0.05). The contrast-enhanced 3D SSFP protocol detected longer lengths for the left anterior descending coronary artery in children younger than 2 years and the left circumflex coronary artery (LCX) in children younger than 5 years (P < 0.05). SNR and CNR of all the coronary arteries in children younger than 5 years and the LCX and right coronary artery in children older than 5 years enhanced after the injection of gadolinium-DTPA (P < 0.05). The intra- and interobserver agreements were high (0.803-0.998) for image quality, length, SNR, and CNR of the coronary arteries in both pre- and postcontrast groups. Conclusion The use of gadolinium contrast in combination with the 3D SSFP sequence is necessary for coronary imaging in children under 2 years of age and may be helpful in children between 2 and 5 years. Coronary artery visualization is not significantly improved in children older than 5 years.
Collapse
Affiliation(s)
- Quanli Shen
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| | - Chengxiang Lin
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| | - Qiong Yao
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| | - Junbo Wang
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| | - Jian Zhou
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| | - Lan He
- Heart Centre, Children’s Hospital of Fudan University, Shanghai, China
| | - Gang Chen
- Heart Centre, Children’s Hospital of Fudan University, Shanghai, China
| | - Xihong Hu
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| |
Collapse
|
4
|
Harrison DJ, Kane DA, Emani SM, Sanders SP, Miller TA, Marx GR. Anomalous Left Coronary Artery Arising from the Pulmonary Artery (ALCAPA): The Critically Important Role of Color Flow Doppler in Identifying a Rare Intramural Course. CASE (PHILADELPHIA, PA.) 2022; 6:119-123. [PMID: 35602985 PMCID: PMC9120850 DOI: 10.1016/j.case.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
•ALCAPA must be considered in an infant with ischemia and/or heart failure. •A rare variant with intramural aortic course may appear normal on 2D echo. •Retrograde color flow in the LCA is highly suspicious for this lesion. •Ambiguous cases will benefit from multimodality imaging via catheterization or CT. •Early recognition may lead to lifesaving surgical correction.
Collapse
Affiliation(s)
- David J. Harrison
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - David A. Kane
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Sitaram M. Emani
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Stephen P. Sanders
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Thomas A. Miller
- Division of Pediatric, Cardiology, Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Gerald R. Marx
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|
5
|
Jiang X, Ye W, Xiao Y, Han L, Ding W, Li W, Jin M, Wang X, Meng Q. Clinical Characteristics of Congenital Atresia of the Left Main Coronary Artery in 12 Children. Front Pediatr 2022; 10:866010. [PMID: 35573961 PMCID: PMC9100423 DOI: 10.3389/fped.2022.866010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/07/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Left main coronary artery atresia (LMCAA) is an extremely rare abnormality and only <100 cases have been reported worldwide. We describe the clinical manifestations, imaging features, prognosis, and treatments of LMCAA who were admitted in our department, which aimed to improve the clinical diagnosis and treatments of LMCAA in children. METHODS A retrospective study identified 12 patients diagnosed with congenital left coronary artery atresia at Pediatric Heart Center of Beijing Anzhen Hospital from June 2010 to June 2019. The clinical characteristics, imaging data, and treatment follow-up were analyzed. RESULTS Among the 12 cases, 8 were boys and 4 were girls; the age of onset was 2 months to 2 years old (median age 7 months); the age of diagnosis was 7 months to 6 years old (median age 2 years and 11 months). At the initial diagnosis, there were 4 cases of respiratory tract infection with cardiac murmur, 3 cases of cardiac shadow enlargement, 1 case of recurrent syncope, 2 cases of feeding difficulty with cardiac enlargement, and 2 cases of simple cardiac murmur. In 12 cases of electrocardiogram examination, 7 cases showed pathological Q waves of lead I, AVL and v4-v6; in 12 cases of chest X-ray examination, 8 cases showed cardiac shadow enlargement; in 12 cases of our hospital's first cardiac ultrasound examination, 4 cases were definitely diagnosed, and 8 cases showed the possibility of left coronary artery abnormality; in 5 cases of cardiac coronary CT angiography examination, 2 cases were confirmed, 2 cases reported suspected left coronary artery abnormality, and 1 case did not report abnormality; All cases were definitely diagnosed in 8 cases of angiography. Follow-up was performed from 1 to 8 years; one case died suddenly, one case of syncope after activity was treated by oral medication, 3 cases received open coronary angioplasty and mitral valvuloplasty, recovered well after operation, the rest of the children were treated by oral medication, and the symptoms are stable at present. CONCLUSIONS Left main coronary artery atresia is difficult to diagnose and can result in heart failure early in life. Timely diagnosis and reasonable treatment are the keys to improve the prognosis.
Collapse
Affiliation(s)
- Xiaokun Jiang
- Department of Pediatric Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Wenqian Ye
- Department of Pediatric Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yanyan Xiao
- Department of Pediatric Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ling Han
- Department of Pediatric Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Wenhong Ding
- Department of Pediatric Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Wenxiu Li
- Department of Pediatric Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Mei Jin
- Department of Pediatric Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xiaofang Wang
- Department of Pediatric Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Qi Meng
- Department of Pediatric Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| |
Collapse
|
6
|
Pediatric cardiothoracic vasculitis: multimodality imaging review. Pediatr Radiol 2022; 52:1895-1909. [PMID: 35790558 PMCID: PMC9256530 DOI: 10.1007/s00247-022-05431-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/19/2022] [Accepted: 06/13/2022] [Indexed: 10/27/2022]
Abstract
The pediatric vasculitides are a relatively uncommon and heterogeneous group of disorders characterized by vessel inflammation, often with cardiothoracic involvement. Diagnosis and monitoring are often clinically challenging because of the nonspecific symptoms and laboratory markers. Thus, imaging has assumed increasing importance for early detection of disease activity, extent and complications as well as long-term monitoring pre- and post-treatment. Herein, we review the major pediatric vasculitides with frequent chest manifestations, including Takayasu arteritis, Kawasaki disease, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, Behçet disease and potential mimics. We highlight key clinical features and management considerations, emphasizing the central role of imaging.
Collapse
|
7
|
Goo HW. Imaging Findings of Coronary Artery Fistula in Children: A Pictorial Review. Korean J Radiol 2021; 22:2062-2072. [PMID: 34564965 PMCID: PMC8628148 DOI: 10.3348/kjr.2021.0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/09/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary artery fistula, defined as an abnormal communication between the coronary arteries and a cardiac chamber (most commonly) or a thoracic great vessel, may result in hemodynamically significant problems due to vascular shunting in children. Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT may be used to evaluate coronary artery fistula in children. Recently, CT has played a pivotal role for the accurate diagnosis of coronary artery fistula in children. Surgical or interventional treatment is performed for hemodynamically significant coronary artery fistulas. In this pictorial review, the detailed imaging findings of coronary artery fistula in children are described.
Collapse
Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
8
|
Tang S, Zhang G, Chen Z, Liu X, He L. Application of prospective ECG-gated multiphase scanning for coronary CT in children with different heart rates. Jpn J Radiol 2021; 39:946-955. [PMID: 34046853 DOI: 10.1007/s11604-021-01133-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To investigate the application of prospective ECG-gated multiphase scanning in coronary CT imaging in children with different heart rates. METHODS In the control group, 160 children aged 2-4 years who underwent a coronary CT examination in our hospital from May 2016 to December 2017 were retrospectively selected. They were divided into five subgroups according to their heart rate frequency: 75-85 beats/min, 86-95 beats/min, 96-105 beats/min, and 106-120 beats/min. There were 40 children in each subgroup. Each child was treated with retrospective ECG-gated scanning technology. Six groups of phase images were reconstructed: 40%, 45%, 50%, 70%, 75% and 80%. The optimal phase was selected for coronary artery reconstruction. In the study group, 240 children aged 2-4 years who underwent coronary artery CT examination in our hospital from January 2018 to May 2019 were prospectively selected and divided into five subgroups according to the heart rate frequency: 75-85 beats/min, 86-95 beats/min, 96-105 beats/min, and 106-120 beats/min. There were 60 children in each subgroup. A prospective ECG-gated multiphase scanning technique was used to reconstruct 70%, 75% and 80% phase images in the subgroups with heart rates < 85/min. In the remaining subgroups, 40%, 45% and 50% phase images were reconstructed, and the optimal phase was selected for coronary artery reconstruction. The scanning parameters, dosage of contrast medium and injection mode of contrast medium were the same in both groups. The radiation dose and image quality of the coronary artery were compared between the two groups at the same heart rate. RESULTS When comparing the two groups at the same heart rate, the radiation dose in the study group was 72% lower than that in the control group (P < 0.05). There was no significant difference in coronary artery image quality between the two groups at the optimal phase (P > 0.05). CONCLUSIONS Applying prospective ECG-gated multiphase scanning technology to children's coronary CT imaging can significantly reduce the scanning radiation dose without affecting the quality of the coronary artery image.
Collapse
Affiliation(s)
- Shilong Tang
- Department of Radiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
| | - Guanping Zhang
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhuo Chen
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianfan Liu
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling He
- Department of Radiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.
| |
Collapse
|
9
|
Goo HW. Anomalous Origin of the Coronary Artery from the Pulmonary Artery in Children and Adults: A Pictorial Review of Cardiac Imaging Findings. Korean J Radiol 2021; 22:1441-1450. [PMID: 34047508 PMCID: PMC8390824 DOI: 10.3348/kjr.2021.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/17/2021] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
Anomalous origin of the coronary artery from the pulmonary artery is a rare and potentially fatal congenital heart defect. Up to 90% of infants with an anomaly involving the left coronary artery die within the first year of life if left untreated. Patients who survive beyond infancy are at risk of sudden cardiac death. Cardiac CT and MRI are increasingly being used for the accurate diagnosis of this anomaly for prompt surgical restoration of the dual coronary artery system. Moreover, life-long imaging surveillance after surgery is necessary for these patients. In this pictorial review, multimodal cardiac imaging findings of this rare and potentially fatal coronary artery anomaly are comprehensively discussed, and representative images are provided to facilitate the understanding of this anomaly.
Collapse
Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
10
|
Goo HW, Siripornpitak S, Chen SJ, Lilyasari O, Zhong YM, Latiff HA, Maeda E, Kim YJ, Tsai IC, Seo DM. Pediatric Cardiothoracic CT Guideline Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 2. Contemporary Clinical Applications. Korean J Radiol 2021; 22:1397-1415. [PMID: 33987995 PMCID: PMC8316776 DOI: 10.3348/kjr.2020.1332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limited to the morphologic evaluation of the extracardiac thoracic vessels, lungs, and airways. Currently, the applications of CT have increased, owing to technological advancements in hardware and software as well as several dose-reduction measures. In the previously published part 1 of the guideline by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed the prerequisite technical knowledge for clinical applications in a user-friendly and vendor-specific manner. Herein, we present the second part of our guideline on contemporary clinical applications of pediatric cardiothoracic CT for CHD based on the consensus of experts from the Asian Society of Cardiovascular Imaging CHD Study Group. This guideline describes up-to-date clinical applications effectively in a systematic fashion.
Collapse
Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Shyh Jye Chen
- Department of Medical Imaging, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Yu Min Zhong
- Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai, China
| | - Haifa Abdul Latiff
- Pediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Eriko Maeda
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - I Chen Tsai
- Congenital Heart Disease Study Group Member of the Asian Society of Cardiovascular Imaging, Taichung, Taiwan
| | - Dong Man Seo
- Department of Cardiothoracic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| |
Collapse
|
11
|
Romeih S, Kaoud A, Shaaban M, Elzoghaby M, Abdelfattah M, Hashem M, Sayed S, Gibreel M, Elmozy W. Coronary artery anomalies in tetralogy of Fallot patients evaluated by multi slice computed tomography; myocardial bridge is not a rare finding. Medicine (Baltimore) 2021; 100:e24325. [PMID: 33607768 PMCID: PMC7899912 DOI: 10.1097/md.0000000000024325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023] Open
Abstract
Based on coronary angiography and interoperative inspection, anomalous origin of coronary artery crossing the right ventricular outflow tract (RVOT) is common in tetralogy of Fallot (TOF) patients. However, other coronary anomalies may be underestimated due to the overlying myocardium, epicardial fat, or adhesions due to previous palliative surgery. Currently, coronary artery visibility dramatically improved by multislice computed tomography (MSCT). We performed this study to assess the coronary arteries anatomy in TOF patients using MSCT.All TOF patients underwent MSCT examination at our centre from 2013 till 2019 were included. Assessment of the coronary arteries' origin and course were performed. Presence of myocardial bridge were assessed, and indexed RV mass was calculated.318 TOF patients were included, median age 2 years (range 1 month-46 years), 175 males (55%). The abnormal coronary artery origin and course were detected in 20 patients (6%); coronary artery crossed RVOT in 13 patients (65%), 5 patients (25%) had a retro-aortic course and 2 patient (10%) had inter-arterial course. Myocardial bridges of left anterior descending artery or/and right coronary artery were reported in 100 patients (36%), no myocardial bridge of left circumflex was reported. RV mass was 29.0 ± 21.1 g/m2. There was no correlation between RV mass and presence of myocardial bridges.MSCT is a useful imaging modality for detection of coronary arteries anomalies in TOF patients. Coronary artery crossing RVOT is not the only abnormal course and myocardial bridging is not a rare finding. Further studies are needed to demonstrate the clinical significance of these observations.
Collapse
Affiliation(s)
- Soha Romeih
- Department of Radiology, Aswan Heart Centre, Aswan
- Department of Cardiology, Tanta University, Tanta
| | - Alaa Kaoud
- Department of Anatomy and Embryology, Asyut University, Asyut
| | - Mahmoud Shaaban
- Department of Radiology, Aswan Heart Centre, Aswan
- Department of Cardiology, Tanta University, Tanta
| | - Mohamed Elzoghaby
- Department of Radiology, Aswan Heart Centre, Aswan
- Department of Cardiology, Tanta University, Tanta
| | - Mohamed Abdelfattah
- Department of Radiology, Aswan Heart Centre, Aswan
- Department of Radiology, Al-Azhar University
| | - Mohamed Hashem
- Department of Anatomy and Embryology, Asyut University, Asyut
| | - Sayed Sayed
- Department of Anatomy and Embryology, Asyut University, Asyut
| | | | - Wesam Elmozy
- Department of Radiology, Aswan Heart Centre, Aswan
- Department of Radiology, Cairo University, Cairo, Egypt
| |
Collapse
|
12
|
Nunes MDO, Witt DR, Casey SA, Stanberry LI, Caye DJ, J Chu B, Lindberg BJ, Lesser JR, Han BK. Safety, Efficacy, and Dose Protocol of Metoprolol for Heart Rate Reduction in Pediatric Outpatients Undergoing Cardiac CT Angiography. Arq Bras Cardiol 2021; 116:100-105. [PMID: 33566972 PMCID: PMC8159495 DOI: 10.36660/abc.20190892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 08/05/2020] [Indexed: 11/28/2022] Open
Abstract
Fundamento Qualidade de imagem e dose de radiação são otimizadas com uma frequência cardíaca (FC) lenta e estável na realização de imagens de artérias coronárias durante a angiografia cardíaca por tomografia computadorizada (CCTA, do inglês
cardiac computed tomography angiography
) A segurança, a eficácia e o protocolo para a redução da FC com medicamento betabloqueador ainda não foi bem descrita em uma população de pacientes pediátricos. Objetivo Oferecer um protocolo de dose de metoprolol eficiente a ser usado em pacientes pediátricos externos durante a CCTA. Métodos Realizamos uma revisão retrospectiva de todos os pacientes pediátricos externos que receberam o metoprolol durante a CCTA. As características demográficas e clínicas foram resumidas e a redução média em FC foi estimada utilizando-se um modelo de regressão linear multivariada. As imagens foram avaliadas em uma escala de 1 a 4 (1= ideal). Resultados Um total de 78 pacientes externos passaram a uma CCTA com o uso de metoprolol. A média de idade foi de 13 anos, a média de peso foi de 46 kg, e 36 pacientes (46%) eram do sexo masculino. As doses médias de metoprolol foram 1,5 (IQR 1,1; 1,8) mg/kg, e 0,4 (IQR 0,2; 0,7) mg/kg para administrações orais e intravenosas, respectivamente. O produto dose-comprimento por exame foi de 57 (IQR 30, 119) mGy*cm. A redução média da FC foi 19 (IQR 12, 26) batimentos por minuto, ou 23%. Não foram relatadas complicações ou eventos adversos. Conclusão O uso de metoprolol num cenário de pacientes pediátricos externos para redução da FC antes de uma CCTA é seguro e eficiente. Pode-se reproduzir um protocolo de dose de metoprolol quando for necessário atingir uma FC mais lenta, garantindo tempos de aquisição mais rápidos, imagens mais claras e redução na exposição à radiação nessa população. (Arq Bras Cardiol. 2021; 116(1):100-105)
Collapse
Affiliation(s)
| | - Dawn R Witt
- Minneapolis Heart Institute and Foundation, Minnesota - EUA
| | - Susan A Casey
- Minneapolis Heart Institute and Foundation, Minnesota - EUA
| | | | - David J Caye
- Minneapolis Heart Institute and Foundation, Minnesota - EUA
| | | | | | - John R Lesser
- Minneapolis Heart Institute and Foundation, Minnesota - EUA
| | - B Kelly Han
- Minneapolis Heart Institute and Foundation, Minnesota - EUA.,Children's Minnesota, Minneapolis, Minnesota - EUA
| |
Collapse
|
13
|
Wang T, Wang C, Zhou KY, Wang XQ, Hu N, Hua YM. Incomplete Kawasaki disease complicated with acute abdomen: A case report. World J Clin Cases 2020; 8:5457-5466. [PMID: 33269284 PMCID: PMC7674722 DOI: 10.12998/wjcc.v8.i21.5457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis characterized by unknown etiology.
CASE SUMMARY A 4.5-year-old boy developed an acute abdomen during the onset of incomplete KD. He still had persistent abdominal pain after undergoing exploratory laparotomy and appendectomy. Ultrasound examination at early onset revealed a giant coronary artery aneurysm. The patient developed a myocardial infarction and heart failure accompanied by respiratory and cardiac arrest. He underwent coronary artery revascularization and coronary artery bypass graft using an autologous internal mammary artery. After the operation, the cardiac output increased, and the symptoms of heart failure resolved. Follow-up evaluation at 1 mo after operation showed that the patient's cardiac function had restored to New York Heart Association standard Grade I heart failure, and normal growth was obtained.
CONCLUSION Coronary artery revascularization and coronary artery bypass graft is an effective method for treating myocardial ischemia in children with KD complicated with giant coronary artery aneurysm . Nevertheless, some issues still need specific attention.
Collapse
Affiliation(s)
- Tao Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610065, Sichuan Province, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu 610041, Sichuan Province, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610065, Sichuan Province, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu 610041, Sichuan Province, China
| | - Kai-Yu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610065, Sichuan Province, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu 610041, Sichuan Province, China
| | - Xiao-Qin Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610065, Sichuan Province, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu 610041, Sichuan Province, China
| | - Na Hu
- Department of Medical Imaging, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi-Min Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610065, Sichuan Province, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
14
|
Wang T, Wang C, Zhou KY, Wang XQ, Hu N, Hua YM. Incomplete Kawasaki disease complicated with acute abdomen: A case report. World J Clin Cases 2020. [PMID: 33269284 DOI: 10.12998/wjcc.v8.i21.5457.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis characterized by unknown etiology. CASE SUMMARY A 4.5-year-old boy developed an acute abdomen during the onset of incomplete KD. He still had persistent abdominal pain after undergoing exploratory laparotomy and appendectomy. Ultrasound examination at early onset revealed a giant coronary artery aneurysm. The patient developed a myocardial infarction and heart failure accompanied by respiratory and cardiac arrest. He underwent coronary artery revascularization and coronary artery bypass graft using an autologous internal mammary artery. After the operation, the cardiac output increased, and the symptoms of heart failure resolved. Follow-up evaluation at 1 mo after operation showed that the patient's cardiac function had restored to New York Heart Association standard Grade I heart failure, and normal growth was obtained. CONCLUSION Coronary artery revascularization and coronary artery bypass graft is an effective method for treating myocardial ischemia in children with KD complicated with giant coronary artery aneurysm . Nevertheless, some issues still need specific attention.
Collapse
Affiliation(s)
- Tao Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Kai-Yu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Qin Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Na Hu
- Department of Medical Imaging, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi-Min Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
15
|
Quantitative evaluation of coronary artery visibility on CT angiography in Kawasaki disease: young vs. old children. Int J Cardiovasc Imaging 2020; 37:1085-1092. [PMID: 33044718 DOI: 10.1007/s10554-020-02054-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/29/2020] [Indexed: 12/19/2022]
Abstract
Coronary artery visibility on coronary CT angiography has rarely been investigated in young children with Kawasaki disease. This retrospective study was performed to quantitatively evaluate and compare coronary artery visibility with sufficient quality to measure it on coronary CT angiography among younger and older children with Kawasaki disease. Seventy-eight consecutive children with Kawasaki disease who underwent coronary CT angiography were divided into two groups: group 1 (age ≤ 6 years; n = 37) and group 2 (age > 6 years and < 18 years; n = 41). The visibility of the right coronary artery, left anterior descending artery, and left circumflex artery was quantitatively evaluated by dividing the length of the assessable coronary artery by the length of the corresponding groove, and compared between the two groups. The coronary artery visibility in group 1 was significantly lower than that in group 2 for the right coronary artery (77.8 ± 26.3% vs. 94.2 ± 13.6%, p < 0.002) and left anterior descending artery (54.8 ± 19.5% vs. 69.6 ± 21.3%, p < 0.003, but the difference was not significant for the left circumflex artery (43.7 ± 23.1% vs. 43.9 ± 26.7%, p > 0.9). In both groups, the visibility of the right coronary artery was the highest, followed by those of the left anterior descending artery and left circumflex artery. Compared with older children with Kawasaki disease, younger children with Kawasaki disease demonstrate significantly lower visibility of the right coronary artery and left anterior descending artery on coronary CT angiography. In contrast, the visibility of the left circumflex artery showed no significant difference between younger and older children with Kawasaki disease.
Collapse
|
16
|
Sayyouh M, Lee E, Bhave N, Kim K, Agarwal PP. Imaging and Management of Coronary Artery Anomalies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
17
|
Kato Y, Ambale-Venkatesh B, Kassai Y, Kasuboski L, Schuijf J, Kapoor K, Caruthers S, Lima JAC. Non-contrast coronary magnetic resonance angiography: current frontiers and future horizons. MAGMA (NEW YORK, N.Y.) 2020; 33:591-612. [PMID: 32242282 PMCID: PMC7502041 DOI: 10.1007/s10334-020-00834-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023]
Abstract
Coronary magnetic resonance angiography (coronary MRA) is advantageous in its ability to assess coronary artery morphology and function without ionizing radiation or contrast media. However, technical limitations including reduced spatial resolution, long acquisition times, and low signal-to-noise ratios prevent it from clinical routine utilization. Nonetheless, each of these limitations can be specifically addressed by a combination of novel technologies including super-resolution imaging, compressed sensing, and deep-learning reconstruction. In this paper, we first review the current clinical use and motivations for non-contrast coronary MRA, discuss currently available coronary MRA techniques, and highlight current technical developments that hold unique potential to optimize coronary MRA image acquisition and post-processing. In the final section, we examine the various research-based coronary MRA methods and metrics that can be leveraged to assess coronary stenosis severity, physiological function, and atherosclerotic plaque characterization. We specifically discuss how such technologies may contribute to the clinical translation of coronary MRA into a robust modality for routine clinical use.
Collapse
Affiliation(s)
- Yoko Kato
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287-0409, USA
| | | | | | | | | | - Karan Kapoor
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287-0409, USA
| | | | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287-0409, USA.
| |
Collapse
|
18
|
Warin Fresse K, Isorni MA, Dacher JN, Pontana F, Gorincour G, Boddaert N, Jacquier A, Raimondi F. Cardiac computed tomography angiography in the paediatric population: Expert consensus from the Filiale de cardiologie pédiatrique et congénitale (FCPC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV). Arch Cardiovasc Dis 2020; 113:579-586. [PMID: 32522436 DOI: 10.1016/j.acvd.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/30/2022]
Abstract
This paper aims to provide a paediatric cardiac computed tomography angiography expert panel consensus based on the opinions of experts from the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) and the Filiale de cardiologie pédiatrique congénitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, computed tomography angiography radiation dose reduction techniques and postprocessing techniques. We think that to realize its full potential and to avoid pitfalls, cardiac computed tomography angiography in children with congenital heart disease requires training and experience. Moreover, paediatric cardiac computed tomography angiography protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible, to prevent unnecessary radiation exposure. We also provide a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.
Collapse
Affiliation(s)
- Karine Warin Fresse
- Imagerie cardiovasculaire fédération des cardiopathies congénitales, CHU de Nantes HGRL, 44093 Nantes, France
| | - Marc Antoine Isorni
- Unité de radiologie diagnostique et thérapeutique, hôpital Marie-Lannelongue, 92350 Le Plessis Robinson, France
| | - Jean Nicolas Dacher
- Cardiac MR/CT Unit, University Hospital, 76031 Rouen, France; Inserm U1096, UFR Médecine-Pharmacie, 76183 Rouen, France
| | - François Pontana
- Inserm UMR 1011, Department of Cardiovascular Radiology, EGID (European Genomic Institute for Diabetes), université de Lille, Institut Cœur-Poumon, Institut Pasteur de Lille, CHU de Lille, FR3508, 59000 Lille, France
| | - Guillaume Gorincour
- Image(2), institut méditerranéen d'imagerie médicale appliquée à la gynecologie, grossesse et enfance, 13008 Marseille, France
| | - Nathalie Boddaert
- Paediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, 75743 Paris, France
| | - Alexis Jacquier
- Department of Radiology, University of Marseille Méditerranée, CHU La Timone, Marseille, France
| | - Francesca Raimondi
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes (M3C), hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
| |
Collapse
|
19
|
Warin-Fresse K, Isornii MA, Dacher JN, Pontana F, Gorincour G, Boddaert N, Jacquier A, Raimondi F. Pediatric cardiac computed tomography angiography: Expert consensus from the Filiale de Cardiologie Pédiatrique et Congénitale (FCPC) and the Société Française d'Imagerie Cardiaque et Vasculaire diagnostique et interventionnelle (SFICV). Diagn Interv Imaging 2020; 101:335-345. [PMID: 32029386 DOI: 10.1016/j.diii.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023]
Abstract
This article was designed to provide a pediatric cardiac computed tomography angiography (CCTA) expert panel consensus based on opinions of experts of the Société Française d'Imagerie Cardiaque et Vasculaire diagnostique et interventionnelle (SFICV) and of the Filiale de Cardiologie Pédiatrique Congénitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, CTA radiation dose reduction techniques, and post-processing techniques. The consensus was based on data from available literature (original papers, reviews and guidelines) and on opinions of a group of specialists with extensive experience in the use of CT imaging in congenital heart disease. In order to reach high potential and avoid pitfalls, CCTA in children with congenital heart disease requires training and experience. Moreover, pediatric cardiac CCTA protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible to prevent unnecessary radiation exposure. We also provided a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.
Collapse
Affiliation(s)
- K Warin-Fresse
- Department of Cardiovascular Imaging, CHU Nantes HGRL, 44093 Nantes, France
| | - M-A Isornii
- Department of Radiology, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
| | - J-N Dacher
- Department of Radiology, Rouen University Hospital, 76031 Rouen, France; Inserm U1096, UFR Médecine-Pharmacie, University of Rouen, 76000 Rouen, France
| | - F Pontana
- Department of Cardiovascular Radiology, Institut Cœur-Poumon, CHU Lille, INSERM UMR 1011, Institut Pasteur de Lille, EGID, FR3508, Univ Lille, 59000 Lille, France
| | - G Gorincour
- Image2, Mediterranean Institute of Medical Imaging, 13008 Marseille, France
| | - N Boddaert
- Pediatric Radiology Unit, Hôpital Universitaire Necker Enfants-Malades, 75015 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - A Jacquier
- Department of Radiology, University of Marseille Méditerranée, CHU la Timone, 13000 Marseille, France
| | - F Raimondi
- Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, 75015 Paris, France.
| |
Collapse
|
20
|
Frommelt P, Lopez L, Dimas VV, Eidem B, Han BK, Ko HH, Lorber R, Nii M, Printz B, Srivastava S, Valente AM, Cohen MS. Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography: Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:259-294. [PMID: 32143778 DOI: 10.1016/j.echo.2019.10.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Frommelt
- Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leo Lopez
- Stanford University, Palo Alto, California
| | | | | | - B Kelly Han
- Children's Minnesota and the Minneapolis Heart Institute, Minneapolis, Minnesota
| | - H Helen Ko
- Kravis Children's Hospital, Mount Sinai Medical Center, New York, New York
| | - Richard Lorber
- Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Masaki Nii
- Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
| | - Beth Printz
- University of California San Diego and Rady Children's Hospital, San Diego, California
| | | | - Anne Marie Valente
- Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meryl S Cohen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
21
|
Barrera CA, Otero HJ, White AM, Saul D, Biko DM. Image Quality of ECG-Triggered High-Pitch, Dual-Source Computed Tomography Angiography for Cardiovascular Assessment in Children. Curr Probl Diagn Radiol 2020; 49:23-28. [DOI: 10.1067/j.cpradiol.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 11/22/2022]
|
22
|
Engineer A, Lim YJ, Lu X, Kim MY, Norozi K, Feng Q. Sapropterin reduces coronary artery malformation in offspring of pregestational diabetes mice. Nitric Oxide 2020; 94:9-18. [PMID: 31600600 DOI: 10.1016/j.niox.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/22/2019] [Accepted: 10/03/2019] [Indexed: 11/24/2022]
Abstract
Endothelial nitric oxide synthase (eNOS) and oxidative stress are critical to embryonic coronary artery development. Maternal diabetes increases oxidative stress and reduces eNOS activity in the fetal heart. Sapropterin (Kuvan®) is an orally active, synthetic form of tetrahydrobiopterin (BH4) and a co-factor for eNOS with antioxidant properties. The aim of the present study was to examine the effects of sapropterin on fetal coronary artery development during pregestational diabetes in mice. Diabetes was induced by streptozotocin to adult female C57BL/6 mice. Sapropterin (10 mg/kg/day) was orally administered to pregnant mice from E0.5 to E18.5. Fetal hearts were collected at E18.5 for coronary artery morphological analysis. Sapropterin treatment to diabetic dams reduced the incidence of coronary artery malformation in offspring from 50.0% to 20.6%. Decreases in coronary artery luminal diameter, volume and abundance in fetal hearts from diabetic mothers, were prevented by sapropterin treatment. Maternal diabetes reduced epicardial epithelial-to-mesenchymal transition (EMT) and expression of transcription and growth factors critical to coronary artery development including hypoxia-inducible factor 1a (Hif1a), Snail1, Slug, β-catenin, retinaldehyde dehydrogenase 2 (Aldh1a2), basic fibroblast growth factor (bFGF) and vascular endothelial group factor receptor 2 (Vegfr2) in E12.5 hearts. Additionally, eNOS phosphorylation was lower while oxidative stress was higher in E12.5 hearts from maternal diabetes. Notably, these abnormalities were all restored to normal levels after sapropterin treatment. In conclusion, sapropterin treatment increases eNOS activity, lowers oxidative stress and reduces coronary artery malformation in offspring of pregestational diabetes. Sapropterin may have therapeutic potential in preventing coronary artery malformation in maternal diabetes.
Collapse
Affiliation(s)
- Anish Engineer
- Department of Physiology and Pharmacology, London, Ontario, Canada
| | - Yong Jin Lim
- Department of Physiology and Pharmacology, London, Ontario, Canada
| | - Xiangru Lu
- Department of Physiology and Pharmacology, London, Ontario, Canada
| | - Mella Y Kim
- Department of Physiology and Pharmacology, London, Ontario, Canada
| | - Kambiz Norozi
- Children's Health Research Institute, London, Ontario, Canada; Department of Paediatrics, Western University, London, Ontario, Canada; Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Germany; Department of Paediatric Cardiology and Intensive Care Medicine, University of Goettingen, Germany
| | - Qingping Feng
- Department of Physiology and Pharmacology, London, Ontario, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada.
| |
Collapse
|
23
|
Secinaro A, Curione D, Mortensen KH, Santangelo TP, Ciancarella P, Napolitano C, Del Pasqua A, Taylor AM, Ciliberti P. Dual-source computed tomography coronary artery imaging in children. Pediatr Radiol 2019; 49:1823-1839. [PMID: 31440884 DOI: 10.1007/s00247-019-04494-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 06/11/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022]
Abstract
Computed tomography (CT) has a well-established diagnostic role in the assessment of coronary arteries in adults. However, its application in a pediatric setting is still limited and often impaired by several technical issues, such as high heart rates, poor patient cooperation, and radiation dose exposure. Nonetheless, CT is becoming crucial in the noninvasive approach of children affected by coronary abnormalities and congenital heart disease. In some circumstances, CT might be preferred to other noninvasive techniques such as echocardiography and MRI for its lack of acoustic window influence, shorter acquisition time, and high spatial resolution. The introduction of dual-source CT has expanded the role of CT in the evaluation of pediatric cardiovascular anatomy and pathology. Furthermore, technical advances in the optimization of low-dose protocols represent an attractive innovation. Dual-source CT can play a key role in several clinical settings in children, namely in the evaluation of children with suspected congenital coronary artery anomalies, both isolated and in association with congenital heart disease. Moreover, it can be used to assess acquired coronary artery abnormalities, as in children with Kawasaki disease and after surgical manipulation, especially in case of transposition of the great arteries treated with arterial switch operation and in case of coronary re-implantation.
Collapse
Affiliation(s)
- Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Davide Curione
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Teresa Pia Santangelo
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Ciancarella
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carmela Napolitano
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessia Del Pasqua
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrew Mayall Taylor
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College of London, Great Ormond Street Hospital for Children, London, UK
| | - Paolo Ciliberti
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
24
|
Rodríguez Martínez M, Ruiz González E, Parra-Llorca A, Torres MV, Aguar Carrascosa M. Myocardial Infarction in Neonates: A Diagnostic and Therapeutic Challenge. Case Rep Pediatr 2019; 2019:7203407. [PMID: 31772807 PMCID: PMC6854977 DOI: 10.1155/2019/7203407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/21/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022] Open
Abstract
Neonatal acute myocardial infarction is an uncommon entity. We describe the case of a 4-day-old term baby who presented with respiratory distress and distal acrocyanosis. The chest radiograph demonstrated cardiomegaly without pleural effusion, and examination revealed hepatomegaly. An electrocardiogram revealed QS pattern in leads I, aVL, and V6, suggestive of ischemia. Cardiac enzymes were elevated, and echocardiogram revealed moderate left ventricular dysfunction with a thrombus at the level of the left atrial appendage. The patient required hemodynamic stabilization, vasodilatation to avoid congestive heart failure, and anticoagulation with heparin and aspirin. In the context of this unusual diagnosis, we reviewed our experience over the last 17 years as well as the existing literature on neonatal myocardial infarction.
Collapse
Affiliation(s)
| | - Eladio Ruiz González
- Division of Cardiology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Anna Parra-Llorca
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Máximo Vento Torres
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Marta Aguar Carrascosa
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
| |
Collapse
|
25
|
Hong SH, Goo HW, Maeda E, Choo KS, Tsai IC. User-Friendly Vendor-Specific Guideline for Pediatric Cardiothoracic Computed Tomography Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 1. Imaging Techniques. Korean J Radiol 2019; 20:190-204. [PMID: 30672159 PMCID: PMC6342752 DOI: 10.3348/kjr.2018.0571] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/30/2018] [Indexed: 12/13/2022] Open
Abstract
Optimal performance of pediatric cardiothoracic computed tomography (CT) is technically challenging and may need different approaches for different types of CT scanners. To meet the technical demands and improve clinical standards, a practical, user-friendly, and vendor-specific guideline for pediatric cardiothoracic CT needs to be developed for children with congenital heart disease (CHD). In this article, we have attempted to describe such guideline based on the consensus of experts in the Asian Society of Cardiovascular Imaging CHD Study Group. This first part describes the imaging techniques of pediatric cardiothoracic CT, and it includes recommendations for patient preparation, scan techniques, radiation dose, intravenous injection protocol, post-processing, and vendor-specific protocols.
Collapse
Affiliation(s)
- Sun Hwa Hong
- Department of Radiology, Mediplex Sejong Hospital, Incheon, Korea
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Eriko Maeda
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - I Chen Tsai
- Congenital Heart Disease Study Group Member of the Asian Society of Cardiovascular Imaging, Taiwan
| | | |
Collapse
|
26
|
Reyna J, Reyes LM, Reyes L, Campos FH, Meza P, Lagunas A, Contreras C, Limón AE. Coronary Artery Dilation in Children with Febrile Exanthematous Illness without Criteria for Kawasaki Disease. Arq Bras Cardiol 2019; 113:1114-1118. [PMID: 31553386 PMCID: PMC7021257 DOI: 10.5935/abc.20190191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/10/2019] [Indexed: 12/15/2022] Open
Abstract
Background Coronary dilatation is the most important complication of Kawasaki disease (KD) and, in addition to some clinical characteristics, is common to KD and febrile exanthematous illnesses (FEIs). Objective To assess whether children with FEI, who do not meet the criteria for KD, have changes in coronary arteries dimensions. Methods Echocardiography was performed within the first two weeks of the disease in patients < 10 years with fever and exanthema without other KD criteria. To make a comparison with KD patients, we reviewed the echocardiograms and medical records of patients with a diagnosis of KD of the last five years. Coronary ectasia was assessed using Z scores of coronary arteries. The means of the dimensions of the coronary arteries were compared with a z test and a level of significance of 0.05 was adopted. Results A total of 34 patients were included, 22 (64.7%) with FEI, and 12(35.2%) with a diagnosis of KD. Using the Z scores of coronary artery, a dilation of any of the coronary artery branches was observed in six (27.2%) patients with FEI. Conclusions An important percentage of patients with FEI has coronary artery dilation.
Collapse
Affiliation(s)
- Jesus Reyna
- Hospital Central Sur de Alta Especialidad - Pediatria, Ciudad de México - México
| | - Luz Marina Reyes
- Hospital Central Sur Pemex - Pediatria, Ciudad de México - México
| | - Lorenzo Reyes
- Hospital Central Sur Pemex - Cardiología, Ciudad de México - México
| | | | | | | | | | | |
Collapse
|
27
|
Harky A, Noshirwani A, Karadakhy O, Ang J. Comprehensive literature review of anomalies of the coronary arteries. J Card Surg 2019; 34:1328-1343. [DOI: 10.1111/jocs.14228] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Arish Noshirwani
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | | | - Juliana Ang
- School of MedicineUniversity of LiverpoolLiverpool UK
| |
Collapse
|
28
|
Schicchi N, Fogante M, Giuseppetti GM, Giovagnoni A. Diagnostic detection with cardiac tomography and resonance of extremely rare coronary anomaly: A case report and review of literature. World J Clin Cases 2019; 7:628-635. [PMID: 30863762 PMCID: PMC6406198 DOI: 10.12998/wjcc.v7.i5.628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/09/2019] [Accepted: 01/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The association of two congenital coronary artery anomalies (CAAs) is extremely rare but represents one of the main cause of sudden cardiac death in young athletes. Although coronary angiography (CX-A) is still widely used in childhood, cardiac magnetic resonance (C-MRI) and cardiac computed tomography (C-CT) have recently taken on an increasing diagnostic role in early detection of CAAs and concomitant congenital cardiac malformations.
CASE SUMMARY A healthy 10-year-old male patient was referred to the Radiological Department of our Institution due to no evidence of left coronary artery in echocardiographic examination. With C-MRI was detected marked myocardial trabeculation and was suspected anomalous origin and course of left circumflex (LCx) artery and of left anterior descending (LAD) artery. With third generation Dual Source C-CT 192x2-sections (SOMATOM Force, Siemens, Germany) was confirmed anomalous origin of LCx artery from right pulmonary artery associated with anomalous origin of LAD artery from right coronary artery with course in front of right ventricular outflow tract. The patient underwent surgical treatment with reimplantation of the anomalous LCX and LAD arteries into the wall of ascending aorta, with no postoperative complications. The patient remained asymptomatic and follow-up C-MRI scan four months after operation showed complete success of surgery treatment.
CONCLUSION This case highlights the diagnostic potential of C-CT and C-MRI in evaluation of CAAs and of cardiac morphology and functionality, with very low radiation dose and without the risks related to invasive procedure.
Collapse
Affiliation(s)
- Nicolò Schicchi
- Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona 60126, Italy
| | - Marco Fogante
- Department of Radiology, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Gian Marco Giuseppetti
- Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona 60126, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona 60126, Italy
| |
Collapse
|
29
|
Image quality and radiation dose of two prospective ECG-triggered protocols using 128-slice dual-source CT angiography in infants with congenital heart disease. Int J Cardiovasc Imaging 2019; 35:937-945. [DOI: 10.1007/s10554-018-01526-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/31/2018] [Indexed: 11/25/2022]
|
30
|
Goo HW. Image Quality and Radiation Dose of High-Pitch Dual-Source Spiral Cardiothoracic Computed Tomography in Young Children with Congenital Heart Disease: Comparison of Non-Electrocardiography Synchronization and Prospective Electrocardiography Triggering. Korean J Radiol 2018; 19:1031-1041. [PMID: 30386135 PMCID: PMC6201980 DOI: 10.3348/kjr.2018.19.6.1031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/08/2018] [Indexed: 12/27/2022] Open
Abstract
Objective To compare image quality and radiation dose of high-pitch dual-source spiral cardiothoracic computed tomography (CT) between non-electrocardiography (ECG)-synchronized and prospectively ECG-triggered data acquisitions in young children with congenital heart disease. Materials and Methods Eighty-six children (≤ 3 years) with congenital heart disease who underwent high-pitch dual-source spiral cardiothoracic CT were included in this retrospective study. They were divided into two groups (n = 43 for each; group 1 with non-ECG-synchronization and group 2 with prospective ECG triggering). Patient-related parameters, radiation dose, and image quality were compared between the two groups. Results There were no significant differences in patient-related parameters including age, cross-sectional area, body density, and water-equivalent area between the two groups (p > 0.05). Regarding radiation dose parameters, only volume CT dose index values were significantly different between group 1 (1.13 ± 0.09 mGy) and group 2 (1.07 ± 0.12 mGy, p < 0.02). Among image quality parameters, significantly higher image noise (3.8 ± 0.7 Hounsfield units [HU] vs. 3.3 ± 0.6 HU, p < 0.001), significantly lower signal-to-noise ratio (105.0 ± 28.9 vs. 134.1 ± 44.4, p = 0.001) and contrast-to-noise ratio (84.5 ± 27.2 vs. 110.1 ± 43.2, p = 0.002), and significantly less diaphragm motion artifacts (3.8 ± 0.5 vs. 3.7 ± 0.4, p < 0.04) were found in group 1 compared with group 2. Image quality grades of cardiac structures, coronary arteries, ascending aorta, pulmonary trunk, lung markings, and chest wall showed no significant difference between groups (p > 0.05). Conclusion In high-pitch dual-source spiral pediatric cardiothoracic CT, additional ECG triggering does not substantially reduce motion artifacts in young children with congenital heart disease.
Collapse
Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| |
Collapse
|
31
|
Barrera CA, Otero HJ, White AM, Saul D, Biko DM. Depiction of the native coronary arteries during ECG-triggered High-Pitch Dual-Source Coronary Computed Tomography Angiography in children: Determinants of image quality. Clin Imaging 2018; 52:240-245. [PMID: 30142610 DOI: 10.1016/j.clinimag.2018.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Assess the image quality of ECG-triggered High-Pitch Dual-Source CTA for the evaluation of native coronaries in children. MATERIALS AND METHODS Between August 2014 and September 2017, 45 children with morphologically normal cardiac chambers had cardiac prospective ECG-triggered High-Pitch Dual-Source CTA. Two pediatric radiologists blinded to clinical data, independently reviewed each case. The coronary arteries were evaluated using a four-point scale quality score according to the coronary segment. Attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured using values from the air, inter-ventricular septum and ascending aorta at the level of the sinuses of Valsalva. RESULTS 225 coronary segments were assessed showed a mean score of 2.40 ± 0.73, 94.2% had diagnostic image quality. The best and worst average quality were seen in segment 5 and 2, respectively. Inter-observer agreement was moderate for all segments except for segment 1, which was excellent. Worse quality scores were significantly associated with younger patients and low body mass index as well as with higher heart rates in all segments. The mean observed heart rate and BSA in patients with diagnostic image quality were below 77 bpm and over 1.4 m2 respectively. There is no significant association between attenuation, SNR and CNR with image quality. CONCLUSIONS Prospective ECG-triggered High-Pitch Dual-Source Computed Tomography Angiography achieves consistent and diagnostic image quality for coronary artery assessment at a low effective dose in pediatric patients.
Collapse
Affiliation(s)
- Christian A Barrera
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Hansel J Otero
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Ammie M White
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - David Saul
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - David M Biko
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
32
|
Coronary artery anomalies on preoperative cardiac CT in children with tetralogy of Fallot or Fallot type of double outlet right ventricle: comparison with surgical findings. Int J Cardiovasc Imaging 2018; 34:1997-2009. [DOI: 10.1007/s10554-018-1422-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
|
33
|
Goo HW. Computed tomography pulmonary vascular volume ratio in children and young adults with congenital heart disease: the effect of cardiac phase. Pediatr Radiol 2018; 48:915-922. [PMID: 29572746 DOI: 10.1007/s00247-018-4120-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/19/2018] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of cardiac phase on CT pulmonary vascular volumetry is unknown. OBJECTIVE To evaluate the effect of cardiac phase on CT pulmonary vascular volume ratio in children and young adults with congenital heart disease. MATERIALS AND METHODS Thirty-one children and young adults (median age 14 years) with congenital heart disease underwent electrocardiography-synchronized cardiothoracic CT at the end-systolic and end-diastolic phases as well as lung perfusion scintigraphy (n=20) or cardiac MRI (n=11). The author calculated right and left pulmonary vascular volumes by using threshold-based CT volumetry. Right pulmonary vascular volume percentages measured by CT obtained at the end-systolic and end-diastolic phases were compared with corresponding values measured by the reference method (lung perfusion scintigraphy or phase-contrast MRI) by using paired t-test and Bland-Altman analysis. RESULTS The right pulmonary vascular volume percentages measured by CT were significantly greater at the end-systolic phase than at the end-diastolic phase (64.0±14.1% vs. 61.9±10.7%; P<0.01). The end-systolic CT right pulmonary vascular volume percentages were not significantly different from the corresponding values measured by the reference method (64.0±14.1% vs. 65.3±13.6%; P>0.05), while the end-diastolic vascular volume percentages were significantly smaller than the corresponding values measured by the reference method (61.9±10.7% vs. 65.3±13.6%; P=0.01). Bland-Altman analysis showed a mean difference of 1.4±7.2% for the end-systolic CT, which was significantly smaller than that for the end-diastolic CT (3.4±7.0%; P<0.01). CONCLUSION The CT pulmonary vascular volume ratio is significantly influenced by the cardiac phase of cardiothoracic CT. The end-systolic phase offers more accurate CT pulmonary vascular volumes than the end-diastolic phase.
Collapse
Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| |
Collapse
|
34
|
Goh YG, Ong CC, Tan G, Liang CR, Soomar SM, Terence Lim CW, Quek SC, Teo LSL. Coronary manifestations of Kawasaki Disease in computed tomography coronary angiography. J Cardiovasc Comput Tomogr 2018; 12:275-280. [PMID: 29426687 DOI: 10.1016/j.jcct.2017.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/10/2017] [Indexed: 12/31/2022]
Abstract
Coronary arteritis in Kawasaki disease can lead to serious complications such myocardial infarction and sudden death. The identification of coronary manifestations with a method that is minimally invasive and of low radiation exposure is therefore important in paediatric patients with Kawasaki disease. Coronary CT angiography can be an attractive alternative to invasive coronary angiography. This paper describes imaging techniques for coronary CT angiography in pediatric patients and demonstrates the spectrum of cardiovascular manifestations in patients with Kawasaki disease.
Collapse
Affiliation(s)
- Yong Geng Goh
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Grace Tan
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Chong Ri Liang
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Sanah Merchant Soomar
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institution National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Chee Wen Terence Lim
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institution National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Swee Chye Quek
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institution National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Li San Lynette Teo
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074.
| |
Collapse
|
35
|
Goo HW. Identification of coronary artery anatomy on dual-source cardiac computed tomography before arterial switch operation in newborns and young infants: comparison with transthoracic echocardiography. Pediatr Radiol 2018; 48:176-185. [PMID: 29032431 DOI: 10.1007/s00247-017-4004-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/21/2017] [Accepted: 09/27/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Considering inherent limitations of transthoracic echocardiography, the diagnostic accuracy of cardiac CT in identifying coronary artery anatomy before arterial switch operation needs to be investigated with recently improved coronary artery visibility using electrocardiogram (ECG)-synchronized dual-source CT. OBJECTIVE To compare diagnostic accuracy between cardiac CT using a dual-source scanner and transthoracic echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants. MATERIALS AND METHODS The study included 101 infants (median age 4 days, range 0 days to 10 months; M:F=78:23) who underwent ECG-synchronized cardiac dual-source CT and transthoracic echocardiography before arterial switch operation between July 2011 and December 2016. We evaluated and classified coronary artery anatomy on cardiac CT and transthoracic echocardiography. With the surgical findings as the reference standard, we compared the diagnostic accuracy for identifying coronary artery anatomy between cardiac CT and transthoracic echocardiography. RESULTS The most common coronary artery pattern was the usual pattern (left coronary artery from sinus 1 and right coronary artery from sinus 2; 64.4%, 65/101), followed by a single coronary artery from sinus 2 and a conal branch from sinus 1 (7.9%, 8/101), the inverted pattern (5.9%, 6/101), the right coronary artery and left anterior descending artery from sinus 1 and the left circumflex artery from sinus 2 (5.9%, 6/101), and others. In 96 infants with surgically proven coronary artery anatomy, the diagnostic accuracy of cardiac CT was significantly higher than that of transthoracic echocardiography (91.7%, 88/96 vs. 54.2%, 52/96; P<0.0001). CONCLUSION Diagnostic accuracy of cardiac CT is significantly higher than that of echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants.
Collapse
Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| |
Collapse
|
36
|
Rigsby CK, McKenney SE, Hill KD, Chelliah A, Einstein AJ, Han BK, Robinson JD, Sammet CL, Slesnick TC, Frush DP. Radiation dose management for pediatric cardiac computed tomography: a report from the Image Gently 'Have-A-Heart' campaign. Pediatr Radiol 2018; 48:5-20. [PMID: 29292481 PMCID: PMC6230472 DOI: 10.1007/s00247-017-3991-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/21/2017] [Accepted: 09/12/2017] [Indexed: 12/28/2022]
Abstract
Children with congenital or acquired heart disease can be exposed to relatively high lifetime cumulative doses of ionizing radiation from necessary medical imaging procedures including radiography, fluoroscopic procedures including diagnostic and interventional cardiac catheterizations, electrophysiology examinations, cardiac computed tomography (CT) studies, and nuclear cardiology examinations. Despite the clinical necessity of these imaging studies, the related ionizing radiation exposure could pose an increased lifetime attributable cancer risk. The Image Gently "Have-A-Heart" campaign is promoting the appropriate use of medical imaging studies in children with congenital or acquired heart disease while minimizing radiation exposure. The focus of this manuscript is to provide a comprehensive review of radiation dose management and CT performance in children with congenital or acquired heart disease.
Collapse
Affiliation(s)
- Cynthia K Rigsby
- Department of Medical Imaging #9, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Radiology and Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA.
| | - Sarah E McKenney
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA
| | - Kevin D Hill
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Anjali Chelliah
- Division of Pediatric Cardiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Andrew J Einstein
- Division of Cardiology, Departments of Medicine and Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - B Kelly Han
- Department of Pediatrics, Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Joshua D Robinson
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Pediatrics and Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina L Sammet
- Department of Medical Imaging #9, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Radiology and Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Timothy C Slesnick
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Donald P Frush
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
37
|
Myocardial delayed-enhancement CT: initial experience in children and young adults. Pediatr Radiol 2017; 47:1452-1462. [PMID: 28534155 DOI: 10.1007/s00247-017-3889-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/01/2017] [Accepted: 05/04/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Clinical utility of myocardial delayed enhancement CT has not been reported in children and young adults. OBJECTIVE To describe initial experience of myocardial delayed enhancement CT regarding image quality, radiation dose and identification of myocardial lesions in children and young adults. MATERIALS AND METHODS Between August 2013 and November 2016, 29 consecutive children and young adults (median age 16 months) with suspected coronary artery or myocardial abnormality underwent arterial- and delayed-phase cardiac CT at our institution. We measured CT densities in normal myocardium, left ventricular cavity, and arterial and delayed hypo-enhancing and delayed hyperenhancing myocardial lesions. We then compared the extent of delayed hyperenhancing lesions with delayed-enhancement MRI or thallium single-photon emission CT. RESULTS Normal myocardium and left ventricular cavity showed significantly higher CT numbers on arterial-phase CT than on delayed-phase CT (t-test, P<0.0001). Contrast-to-noise ratios of the arterial and delayed hypo-enhancing and delayed hyperenhancing lesions on CT were 26.7, 17.6 and 18.7, respectively. Delayed-phase CT findings were equivalent to those of delayed-enhancement MRI in all cases (7/7) and to those of thallium single-photon emission CT in 70% (7/10). CONCLUSION Myocardial delayed-enhancement CT can be added to evaluate myocardial lesions in select children and young adults with suspected coronary artery or myocardial abnormality.
Collapse
|
38
|
Bang JH, Park JJ, Goo HW. Evaluation of commissural malalignment of aortic-pulmonary sinus using cardiac CT for arterial switch operation: comparison with transthoracic echocardiography. Pediatr Radiol 2017; 47:556-564. [PMID: 28243677 DOI: 10.1007/s00247-017-3786-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/12/2016] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are limited data regarding the influence of commissural malalignment of the aortic-pulmonary sinus on the arterial switch operation. OBJECTIVE To compare diagnostic accuracy between cardiac CT and echocardiography for evaluating commissural malalignment of aortic-pulmonary sinus in children with complete transposition of the great arteries and to seek potential clinical implication of commissural malalignment on the arterial switch operation. MATERIALS AND METHODS In 37 patients (35 boys; median age: 8 days, range: 3-80 days) with complete transposition of the great arteries who had tricuspid semilunar valves and underwent an arterial switch operation, the degree of the commissural rotation of the aortic-pulmonary sinus was assessed on cardiac CT (n=37) and echocardiography (n=35). With surgical finding as a reference, cardiac CT was compared with echocardiography in identifying commissural malalignment in 35 patients. The influence of the height difference between the semilunar valves measured by cardiac CT on the identification of commissural malalignment with cardiac CT and echocardiography was evaluated. The impact of commissural malalignment on coronary transfer techniques was evaluated. RESULTS In operative findings, the commissures of the semilunar valves were aligned in 24 patients and malaligned in 13. With surgical findings as a reference, cardiac CT showed higher, but not statistically significant (P>0.05), sensitivity (91.7% vs. 75.0%), specificity (87.0% vs. 78.3%) and accuracy (88.6% vs. 77.1%) for the diagnosis of the malalignment than echocardiography. The measured height difference between the semilunar valves did not affect the identification of the malalignment with cardiac CT and echocardiography. The surgical malalignment group showed a higher requirement of modified coronary transfer techniques than the surgical aligned group (11/13 vs. 11/24, P=0.03). CONCLUSION Cardiac CT and echocardiography appear useful for evaluating commissural malalignment of the semilunar valves in patients with complete transposition of the great arteries frequently requiring modified coronary transfer techniques at during an arterial switch operation.
Collapse
Affiliation(s)
- Ji Hyun Bang
- Divisions of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Jun Park
- Divisions of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| |
Collapse
|
39
|
Agarwal PP, Dennie C, Pena E, Nguyen E, LaBounty T, Yang B, Patel S. Anomalous Coronary Arteries That Need Intervention: Review of Pre- and Postoperative Imaging Appearances. Radiographics 2017; 37:740-757. [PMID: 28388272 DOI: 10.1148/rg.2017160124] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronary artery anomalies constitute a diverse group of abnormalities, ranging from anatomic variants to those having hemodynamic consequences. This review focuses on major anomalies that have clinical implications requiring treatment, including anomalous origin of the coronary artery from the opposite sinus with interarterial course specifically with an intramural course, coronary artery origin from the pulmonary artery, and coronary artery fistula. Comprehensive imaging evaluation is necessary to precisely delineate the anatomy as well as pathophysiologic aspects of the anomaly before determining treatment options for a specific patient. Coronary computed tomographic angiography provides elegant depiction of coronary arterial anatomy and the relationship of the vessel to the adjacent structures, with the ability to perform three-dimensional reconstructions. Magnetic resonance (MR) imaging is emerging as an alternative noninvasive imaging strategy, particularly in young individuals, due to the lack of ionizing radiation and avoidance of iodinated contrast agents. This review describes the roles and recent technical advancements in computed tomography and MR imaging pertinent to coronary artery imaging. Additionally, this article will familiarize readers with the cross-sectional imaging appearance of clinically relevant coronary anomalies, hemodynamic considerations, and complex decision making. The different management strategies used for these anomalies, such as coronary unroofing, reimplantation, bypass grafting, Takeuchi repair, and surgical and interventional closure of fistulas, as well as specific posttreatment complications, are also discussed. ©RSNA, 2017.
Collapse
Affiliation(s)
- Prachi P Agarwal
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Carole Dennie
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Elena Pena
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Elsie Nguyen
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Troy LaBounty
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Bo Yang
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Smita Patel
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| |
Collapse
|
40
|
Mosca RS, Phoon CKL. Anomalous Aortic Origin of a Coronary Artery Is Not Always a Surgical Disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 19:30-6. [PMID: 27060040 DOI: 10.1053/j.pcsu.2015.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/11/2022]
Abstract
Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus of Valsalva with an interarterial course has become a high-profile lesion as a result of its association with sudden cardiac death in otherwise young and healthy individuals. Despite our incomplete knowledge of its pathophysiology and natural history, surgical intervention is often recommended. Evidence now shows AAOCA to be relatively common, with lower than previously suspected rates of sudden cardiac death. Analysis of this information reveals that AAOCA is not always a surgical disease. Future multi-institutional studies will continue to define those subgroups best served by observation or surgery.
Collapse
Affiliation(s)
- Ralph S Mosca
- George E. Reed Professor of Cardiac Surgery Vice Chairman, Clinical Affairs, Chief, Division of Congenital Cardiac Surgery, NYU Langone Medical Center, New York, NY
| | - Colin K L Phoon
- Division of Pediatric Cardiology, NYU Langone Medical Center, New York, NY.
| |
Collapse
|
41
|
Vaalma S, Rahmer J, Panagiotopoulos N, Duschka RL, Borgert J, Barkhausen J, Vogt FM, Haegele J. Magnetic Particle Imaging (MPI): Experimental Quantification of Vascular Stenosis Using Stationary Stenosis Phantoms. PLoS One 2017; 12:e0168902. [PMID: 28056102 PMCID: PMC5215859 DOI: 10.1371/journal.pone.0168902] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/08/2016] [Indexed: 11/29/2022] Open
Abstract
Magnetic Particle Imaging (MPI) is able to provide high temporal and good spatial resolution, high signal-to-noise ratio and sensitivity. Furthermore, it is a truly quantitative method as its signal strength is proportional to the concentration of its tracer, superparamagnetic iron oxide nanoparticles (SPIOs). Because of that, MPI is proposed to be a promising future method for cardiovascular imaging. Here, an interesting application may be the quantification of vascular pathologies like stenosis by utilizing the proportionality of the SPIO concentration and the MPI signal strength. In this study, the feasibility of MPI based stenosis quantification is evaluated based on this application scenario. Nine different stenosis phantoms with a normal diameter of 10 mm each and different stenoses of 1–9 mm and ten reference phantoms with a straight diameter of 1–10 mm were filled with a 1% Resovist dilution and measured in a preclinical MPI-demonstrator. The MPI signal intensities of the reference phantoms were compared to each other and the change of signal intensity within each stenosis phantom was used to calculate the degree of stenosis. These values were then compared to the known diameters of each phantom. As a second measurement, the 5 mm stenosis phantom was used for a serial dilution measurement down to a Resovist dilution of 1:3200 (0.031%), which is lower than a first pass blood concentration of a Resovist bolus in the peripheral arteries of an average adult human of at least about 1:1000. The correlation of the stenosis values based on MPI signal intensity measurements and based on the known diameters showed a very good agreement, proving the high precision of quantitative MPI in this regard.
Collapse
Affiliation(s)
- Sarah Vaalma
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Jürgen Rahmer
- Research Laboratories, Philips Technologie GmbH Innovative Technologies, Hamburg, Germany
| | - Nikolaos Panagiotopoulos
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Robert L. Duschka
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Jörn Borgert
- Research Laboratories, Philips Technologie GmbH Innovative Technologies, Hamburg, Germany
| | - Jörg Barkhausen
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Florian M. Vogt
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Julian Haegele
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Lübeck, Germany
- * E-mail:
| |
Collapse
|
42
|
Contrast-Enhanced High-Pitch Computed Tomography in Pediatric Patients Without Electrocardiography Triggering and Sedation. J Comput Assist Tomogr 2017; 41:165-171. [DOI: 10.1097/rct.0000000000000482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Shen Q, Yao Q, Hu X. Anomalous origin of the left coronary artery from the pulmonary artery in children: diagnostic use of multidetector computed tomography. Pediatr Radiol 2016; 46:1392-8. [PMID: 27240814 DOI: 10.1007/s00247-016-3635-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/10/2016] [Accepted: 04/27/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly. It is important to demonstrate the anomalous origin of the left coronary artery and its course before surgery. OBJECTIVE To explore the clinical diagnostic use of multidetector CT coronary angiography in detecting anomalous origin of the left coronary artery from the pulmonary artery in children. MATERIALS AND METHODS Nine children (2 boys, 7 girls) ages 2 months to 9 years with surgically confirmed anomalous origin of the left coronary artery from the pulmonary artery were studied. Clinical data, transthoracic echocardiography and CT coronary angiography images were retrospectively analyzed. RESULTS Transthoracic echocardiography correctly diagnosed anomalous origin of the left coronary artery from the pulmonary artery in 7 of 9 patients (95% CI: 40-97%). CT coronary angiography revealed the anomalous origin of the left coronary artery in all children (95% CI: 66-100%). In a 4-year-old girl and a 9-year-old girl, CT coronary angiography showed dilation of the right coronary artery and collateral circulation between the right and the left coronary arteries. CONCLUSION CT coronary angiography is a useful method to show the anomalous origin of the coronary artery in children with anomalous origin of the left coronary artery from the pulmonary artery, especially for patients in whom origin of the left coronary artery cannot be detected by transthoracic echocardiography.
Collapse
Affiliation(s)
- Quanli Shen
- Department of Radiology, Children's Hospital of Fudan University, 399 Wanyuan St., Shanghai, 201102, China
| | - Qiong Yao
- Department of Radiology, Children's Hospital of Fudan University, 399 Wanyuan St., Shanghai, 201102, China
| | - Xihong Hu
- Department of Radiology, Children's Hospital of Fudan University, 399 Wanyuan St., Shanghai, 201102, China.
| |
Collapse
|
44
|
Raimondi F, Warin-Fresse K. Computed tomography imaging in children with congenital heart disease: Indications and radiation dose optimization. Arch Cardiovasc Dis 2016; 109:150-7. [PMID: 26782623 DOI: 10.1016/j.acvd.2015.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022]
Abstract
Computed tomography (CT) technology is acquiring a key role in the diagnostic process of complex cardiac congenital anomalies. Recent advances and improvements in spatial and temporal resolution and radiation dose are encouraging the use of CT scanning in children. Paediatric cardiologists should have a good knowledge of the potential of CT techniques and their limitations to plan and properly perform CT examinations without forgetting radiation concerns. In this paper, we will discuss the principal indications for CT scans in newborns and children in our clinical practice. We will also outline the most-used strategies for dose reduction. Basic knowledge about the various CT techniques is crucial, not only to perform, but also to interpret CT results, thus helping the medical and surgical management of patients.
Collapse
Affiliation(s)
- Francesca Raimondi
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, service de radiologie pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France.
| | - Karine Warin-Fresse
- Imagerie cardiovasculaire, fédération des cardiopathies congénitales, CHU de Nantes, 44093 Nantes cedex 1, France
| |
Collapse
|