Safety and accuracy of 64-slice computed tomography coronary angiography in children after the arterial switch operation for transposition of the great arteries.
OBJECTIVE
We investigated the accuracy of 64-slice computed tomography (CT) angiography, as compared to invasive angiography, to evaluate reimplanted coronary arteries in children after arterial switch operation (ASO) for transposition of the great arteries (TGA).


BACKGROUND
Assessment of the integrity of reimplanted coronary arteries is crucial for long-term outcome after ASO for TGA. Noninvasive tests have limited accuracy for detecting significant coronary lesions, and invasive coronary angiography is usually required in this setting.


METHODS
One hundred thirty consecutive children, after ASO for TGA (age 5.6 +/- 1.1 years), underwent conventional invasive coronary angiography and coronary CT angiography using a 64-slice scanner. The ability of CT to detect significant coronary stenoses (>30% diameter reduction) of the coronary ostia and proximal segments, and other abnormalities of the coronary arteries was analyzed by blinded comparison to the invasive coronary angiogram.


RESULTS
The CT was fully evaluable in 126 of 130 patients (97%), allowing assessment of ostia and proximal segments of all coronary arteries. The CT correctly detected all 12 patients (9.2%) in whom invasive coronary angiography had identified significant coronary lesions, with a sensitivity, specificity, and negative predictive value of 100%. In addition, CT showed nonsignificant coronary lesions (<30% luminal narrowing) in 6 patients and allowed determination of the underlying reasons for coronary luminal narrowing, such as stretching or compression of the re-implanted coronary arteries caused by their anatomic relationship to the adjacent great vessels.


CONCLUSIONS
64-slice CT coronary angiography performs as well as invasive angiography for detecting significant coronary lesions in the majority of children who have undergone the arterial switch procedure for TGA. CT also provides information on the underlying mechanism of coronary luminal narrowing.
University Rene Descartes-Paris V, UFR Necker-Enfants Malades, Department of Pediatric Radiology, 149 rue de Sèvres, Paris Cedex 15, France. phalla.ou@nck.aphp.fr
Phalla
P
Ou
David S
DS
Celermajer
Davide
D
Marini
Gabriella
G
Agnoletti
Pascal
P
Vouhé
Francis
F
Brunelle
Kim-Hanh
KH
Le Quan Sang
Jean Christophe
JC
Thalabard
Daniel
D
Sidi
Damien
D
Bonnet
D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D005240:Feasibility Studies; D006801:Humans; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012092:Replantation / Q000009:adverse effects; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000009:adverse effects; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
D003287:Contrast Media