155 - CT CORONARY ANGIOGRAPHY IS THE PREFERRED IMAGING MODALITY FOR LEFT CIRCUMFLEX CORONARY ARTERY IN CHILDREN WITH KAWASAKI DISEASE: 9 YEARS OF EXPERIENCE FROM A TERTIARY CENTRE IN NORTH INDIA

Background: Kawasaki disease (KD) is a systemic vasculitis that preferentially affects coronary arteries. Two-dimensional transthoracic echocardiography (TTE) has been the preferred modality for coronary artery imaging in children with KD. TTE, however, has several limitations. For instance, coronary artery abnormalities (CAAs) involving left circumflex artery (LCx) can be missed on TTE. In this study, we have evaluated the involvement of LCx in children with KD on computed tomography coronary angiography (CTCA) performed on a 128-slice dual source platform.

Methodology: Diagnosis of KD was based on American Heart Association (AHA) guidelines. Radiation-optimized CTCA was performed in 225 children with KD over 9 years (November 2013 – December 2022). TTE was performed on the same day or a day, prior or after, CTCA. Patients were managed using AHA-based treatment protocols.

Results: On CTCA, involvement of LCx was seen in 41/225 (18.2%) patients with KD. However, TTE detected LCx abnormalities in only 15/41 (36.6%) patients. Four patients (9.75%) had isolated LCx involvement. CTCA showed 47 CAAs in LCx in 41 patients. Aneurysms (40 fusiform; 2 saccular) were seen in 39 patients; stenoses in 3; thrombosis in 2. One patient had an aneurysm and a stenosis, while 2 patients had only stenoses. Thromboses and stenoses had both been missed on TTE. Giant aneurysms in LCx were seen in 7 patients. Proximal LCx aneurysms were seen in 39 patients - of these, 12 had distal extension as well. Distal LCx aneurysms, in absence of proximal involvement, were seen in 6 patients. Two patients had non-contiguous multiple aneurysms. Based on findings of the CTCA, treatment protocols had to be modified in 3/41 (7.3%) patients.

Conclusions: TTE alone is inadequate for the assessment of LCx in children with KD. Abnormalities of LCx were seen in 18.2% (41/225) patients on CTCA. Majority of these (26/41; 63.4%) had been missed on TTE. Isolated LCx CAAs were seen in 4/41 (9.75%) patients. Based on these findings, CTCA should be considered an essential imaging modality for the complete assessment of LCx. Our results have important implications for treatment planning and follow-up of children with KD.