65 - FOLLOW-UP CT CORONARY ANGIOGRAPHY IN 37 CHILDREN WITH KD HAVING CORONARY ARTERY ABNORMALITIES: 10 YEARS OF EXPERIENCE

Background: Coronary artery abnormalities (CAAs) of KD mandate long term surveillance. ECHO, hitherto the imaging modality of choice, has several limitations for follow-up of CAAs. Computed Tomography Coronary Angiography (CTCA) on present day CT scanners with radiation optimization capabilities has enabled comprehensive evaluation of coronary arteries in children with KD on follow-up. This study pertains to role of follow-up CTCA in children with KD having CAAs at a tertiary care center in Chandigarh, North India

Methods: CTCA was carried out on 298 children on dual-source CT scanners-128-detectors Definition Flash/ 192-detectors-Force (Siemens, Erlangen, Germany) during the period 2013-2023. Follow-up CTCA was performed in 37/298 children.

Results:  Median age at diagnosis: 48 months [range 4-96 months]. Median interval between the first and second CTCA examination: 37 months [range 6-85 months].

CTCA at presentation: revealed 38 aneurysms in 20 patients and 32 dilatations in 14 patients. Giant aneurysms were seen in 6 patients (LAD – 5; RCA-3). Four patients had multiple complex aneurysms, while 2 children had multiple aneurysms with beaded appearance (RCA & LAD). Thrombosis was seen in 4 patients (LAD).  

Follow-up CTCA: In 18/37 (48 %) patients CAAs had normalized and in remaining 19/37 (52%) there were persistent CAAs. These included partial regression, remodeling of aneurysms, stenosis, thrombus or mural calcifications.

Mural calcifications were seen in 10 aneurysms in 6 patients. Thrombosis was still present in 2 patients. Three patients revealed stenosis (all in LAD): one with long segment stenosis and mural calcification, one having focal stenosis up to 80%, and one having two discontinuous focal areas of severe stenosis (up to 80%). One patient developed thrombus in fusiform aneurysm of LAD after 42 months.

9 dilatations in 4 children showed persistent dilatations without any change while thirty dilatations in 16 children showed partial regression.

Conclusions: Children with KD and CAAs require prospective long-term follow-up as they may develop complications like thrombosis, stenosis, and calcifications. CTCA provides more detailed and comprehensive evaluation in comparison to ECHO, inasmuch as several CAAs can be missed on ECHO. In our experience, CTCA is the standard of care imaging modality during follow-up of children with KD.