title: Coronary artery imaging in grown up congenital heart disease: complementary role of magnetic resonance and x-ray coronary angiography.
abstract: BACKGROUND
  There is a high incidence of anomalous coronary arteries in subjects with congenital heart disease. These abnormalities can be responsible for myocardial ischemia and sudden death or be damaged during surgical intervention. It can be difficult to define the proximal course of anomalous coronary arteries with the use of conventional x-ray coronary angiography. Magnetic resonance coronary angiography (MRCA) has been shown to be useful in the assessment of the 3-dimensional relationship between the coronary arteries and the great vessels in subjects with normal cardiac morphology but has not been used in patients with congenital heart disease.
  
  
  RESULTS
  Twenty-five adults with various congenital heart abnormalities were studied. X-ray coronary angiography and respiratory-gated MRCA were performed in all subjects. Coronary artery origin and proximal course were assessed for each imaging modality by separate, blinded investigators. Images were then compared, and a consensus diagnosis was reached. With the consensus readings for both magnetic resonance and x-ray coronary angiography, it was possible to identify the origin and course of the proximal coronary arteries in all 25 subjects: 16 with coronary anomalies and 9 with normal coronary arteries. Respiratory-gated MRCA had an accuracy of 92%, a sensitivity of 88%, and a specificity of 100% for the detection of abnormal coronary arteries. The MRCA results were more likely to agree with the consensus for definition of the proximal course of the coronary arteries (P<0.02).
  
  
  CONCLUSIONS
  For the assessment of anomalous coronary artery anatomy in patients with congenital heart disease, the use of the combination of MRCA with x-ray coronary angiography improves the definition of the proximal coronary artery course. MRCA provides correct spatial relationships, whereas x-ray angiography provides a view of the entire coronary length and its peripheral run-off. Furthermore, respiratory-gated MRCA can be performed without breath holding and with only limited subject cooperation.
authors.affiliation: Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Taylor
authors.forename: S A
authors.initials: SA
authors.lastname: Thorne
authors.forename: M B
authors.initials: MB
authors.lastname: Rubens
authors.forename: P
authors.initials: P
authors.lastname: Jhooti
authors.forename: J
authors.initials: J
authors.lastname: Keegan
authors.forename: P D
authors.initials: PD
authors.lastname: Gatehouse
authors.forename: F
authors.initials: F
authors.lastname: Wiesmann
authors.forename: F
authors.initials: F
authors.lastname: Grothues
authors.forename: J
authors.initials: J
authors.lastname: Somerville
authors.forename: D J
authors.initials: DJ
authors.lastname: Pennell
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D012119:Respiration; D016037:Single-Blind Method