ACCURATEZZA DELLA TOMOGRAFIA COMPUTERIZZATA MULTISTRATO NELLA DIAGNOSI DI COMPLICANZE CORONARICHE DOPO CHIRURGIA DI REIMPIANTO CORONARICO IN ETA’ PEDIATRICA

OBJECTIVES: We investigated the accuracy of 32-slice computed tomography (CT) angiography, as compared to invasive angiography, to evaluate reimplanted coronary arteries in children after reimplantation coronary surgery because of congenital heart diseases. BACKGROUND: Assessment of the integrity of reimplanted coronary arteries is crucial for long-term outcome in children. Non-invasive tests have limited accuracy for detecting significant coronary lesions, and invasive coronary angiography is usually required in this setting. METHODS: Thirty eight consecutive children (age 8.6 +/- 4.1 years), N=24 after Arterial Switch Operation (ASO) for Transposition of Great Arteries (TGA), N=8 after reimplantation of the left coronary artery because of Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) and N=6 after Ross Operation because aortic valve diseases underwent conventional invasive coronary angiography and coronary CT angiography using a 32-slice scanner. The ability of CT to detect significant coronary stenoses (>50% 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 100% patients, allowing assessment of ostia and proximal segments of all coronary arteries. The CT correctly detected all 4 patients (10.5%) 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 lesion (<50% luminal narrowing) in 1 patient and allowed determination of the underlying reasons for coronary luminal narrowing, such as intimal proliferation, stretching or compression of the re-implanted coronary arteries caused by their anatomic relationship to the adjacent great vessels. CONCLUSIONS: 32-slice CT coronary angiography performs as well as invasive angiography for detecting significant coronary lesions in children who have undergone coronary reimplantation surgery. CT also provides information on the underlying mechanisms of coronary luminal narrowing.