Safety and Accuracy of 64-Slice Computed Tomography Coronary Angiography in Children After the Arterial Switch Operation for Transposition of the Great Arteries
Phalla Ou, MD, PhD*, ,*,
David S. Celermajer, MBBS, DSc, FRACP ,
Davide Marini, MD,
Gabriella Agnoletti, MD, PhD,
Pascal Vouhé, MD, PhD,
Francis Brunelle, MD*,
Kim-Hanh Le Quan Sang, MD ,
Jean Christophe Thalabard, MD, PhD¶,
Daniel Sidi, MD, PhD,
Damien Bonnet, MD, PhD
* University Rene Descartes-Paris V, UFR Necker-Enfants Malades, Department of Pediatric Radiology, AP-HP, Paris, France
Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Université René Descartes-Paris V, UFR Necker-Enfants Malades, Paris, France
Department of Medicine, University of Sydney, Sydney, Australia
University René Descartes-Paris V, UFR Necker-Enfants Malades, Clinical Pharmacology, Department of Genetics, AP-HP, Paris, France
¶ MAP5, UMR CNRS 8145, Université Paris Descartes-Paris V, AP-HP, Paris, France.
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Figure 1 Left Main Coronary Artery With a Course Between Aorta and Pulmonary Artery
Axial (A) and sagittal oblique (B) cross-section through the origin of the left coronary artery. The left coronary artery displays a tight stenosis (arrow) and follows a course between the aorta and pulmonary artery. (C) Corresponding invasive angiogram: selective catheterization of the left coronary ostium was not achieved. Selective right coronary angiography shows a dominant right coronary artery giving rise to a circumflex artery retrogradely filling the left anterior descending artery. Ao = aorta; LA = left atrium; LAD = left anterior descending coronary artery; LV = left ventricle, PA = pulmonary artery.
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Figure 2 Stretching of the Circumflex Artery
Oblique multiplanar reconstruction (A) showing the origin of the right coronary artery in a child presenting with a Yacoub type D coronary distribution. The left circumflex artery arises from the right neosinus and follows a long retroaortic course with substrantial stretching of its proximal segment (arrow). A neosinus had been surgically created to treat a stenosis of the right ostium. (B) Corresponding invasive angiogram: selective catheterization of the right neosinus, showing the right coronary artery and the stenosis (arrow) of the proximal segment of the retroaortic circumflex artery. Abbreviations as in Figure 1.
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Figure 3 Ostial Stenosis of the Left Main Coronary Artery
Axial cross-section (A) and 3-dimensional reconstructed image in anterosuperior orientation (B) showing a tight stenosis (arrow) at the ostium of the left coronary artery. Please note that the left ostium is reimplanted at an anterior 12 o'clock position so that it is localized between the great arteries. (C) Corresponding invasive aortography showing the tight stenosis of the left coronary artery ostium. Abbreviations as in Figure 1.
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Figure 4 Mild Compression of the Right Coronary Artery
Axial cross-section (maximum intensity projection) (A) and 3-dimensional reconstruction (B) showing a single coronary ostium from which both the right and left coronary arteries arise. There is mild compression of a long segment of the right coronary artery between the great arteries. The left coronary artery has a retroaortic loop with no stretching or compression. (C) Selective invasive angiogram of the right coronary artery: the proximal segment was classified as normal. Abbreviations as in Figure 1.
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Figure 5 Systolic Compression of the Left Coronary Artery
(Top) Sagittal oblique cross-section on CT. Note the banana-shape of the left coronary artery (arrow) caused by systolic compression between the anterior pulmonary artery the posterior aorta (left panel). During diastole, caliber and shape of the coronary artery are normal (right panel). (Bottom) Corresponding invasive angiogram: the systolic compression of the proximal segment of the left coronary artery appears nonsignificant. Abbreviations as in Figure 1.
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