title: Diagnostic accuracy of dual-source multislice computed tomographic analysis for the preoperative detection of coronary artery anomalies in 100 patients with tetralogy of Fallot.
abstract: OBJECTIVE
  A detailed preoperative evaluation of coronary anatomy is mandatory before surgical intervention for tetralogy of Fallot. In pediatric patients, the preoperative evaluation of coronary anatomy has relied classically on conventional angiographic analysis and, more recently, on echocardiographic analysis, which have well-known limitations and complications. Recent technological improvements allow the use of multislice computed tomographic analysis to evaluate coronary artery anatomy in very young children, even those with high heart rates. The purpose of this prospective study was to assess the accuracy of preoperative dual-source computed tomographic analysis in detecting coronary artery abnormalities by using surgical findings as the reference standard.
  
  
  METHODS
  We prospectively evaluated 100 patients with tetralogy of Fallot before surgical intervention between November 2006 and September 2009 by using dual-source computed tomographic analysis with either retrospective, electrocardiographically gated, helical computed tomographic analysis or prospective, electrocardiographically triggered, sequential computed tomographic acquisition. The patients had a median age of 6.8 months (range, 1.2 months-6.8 years) and a median weight of 7.9 kg (range, 3-30 kg).
  
  
  RESULTS
  Compared with surgical findings, dual-source computed tomographic analysis had 100% sensitivity and 100% specificity for detecting coronary artery abnormalities. Major coronary artery abnormalities were found in 7 (7%) patients. The radiation dose was low.
  
  
  CONCLUSIONS
  Dual-source computed tomographic analysis is an accurate and noninvasive tool for delineating coronary artery anatomy before surgical intervention in children with tetralogy of Fallot. Dual-source computed tomographic analysis might deserve to be used routinely instead of angiographic analysis and in combination with echocardiographic analysis for the preoperative assessment of patients with tetralogy of Fallot.
authors.affiliation: Department of Pediatric Cardiac Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Vastel-Amzallag
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Le Bret
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Paul
authors.forename: Virginie
authors.initials: V
authors.lastname: Lambert
authors.forename: Adela
authors.initials: A
authors.lastname: Rohnean
authors.forename: Eric
authors.initials: E
authors.lastname: El Fassy
authors.forename: Anne
authors.initials: A
authors.lastname: Sigal-Cinqualbre
mesh_terms: D006348:Cardiac Surgical Procedures; D055424:Cardiac-Gated Imaging Techniques; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D011829:Radiation Dosage; D012680:Sensitivity and Specificity; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging* / Q000601:surgery; D036542:Tomography, Spiral Computed; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography