67 - ROLE OF COMPUTED TOMOGRAPHY ANGIOGRAPHY IN CHILDREN WITH KD AT PRESENTATION: A COMPARATIVE STUDY WITH ECHO

Background/

Aim: Coronary artery abnormalities (CAAs) of KD demand precise diagnosis at presentation for treatment and subsequent follow-up. ECHO is currently the standard for imaging coronary arteries. It, however, has inherent limitations: operator dependency, inaccurate evaluation of middle/distal coronary artery segments. Computed tomography coronary angiography (CTCA) is a feasible option to address limitations of ECHO.

The aim of this study is to present our experience on usefulness of CTCA at presentation in assessment of CAAs of KD and comparison with ECHO.

Methods:

CTCA at presentation was done in 105/298 children with radiation optimization in last 10 years (2013-2023). CTCA was carried once child stabilised after appropriate treatment on 128- detectors/192- detectors dual source CT (DSCT). CTCA was done if CAAs were found on ECHO or unequivocal ECHO done independently by two operators. ECHO was repeated a day prior/ same day of CTCA and results of CTCA  were then compared with ECHO.

CTCA was done without sedation/anaesthesia in children > 5 years of age. All children below 5 years or who didn’t cooperate syrup triclofos (50mg/kg) was given 30 minutes before procedure or Intravenous midazolam (0.1mg/kg) who were not sedated by triclofos.

Results:  105/298 children underwent CTCA at presentation. CAAs were as follows: left anterior descending artery (LAD)- 20 dilatations in 18 patients and 26 aneurysms in 24 patients; Right coronary artery (RCA)- 14 dilatations in 14 patients and 20 aneurysms in 16 patients; left main coronary artery (LMCA)- 13 dilatations in 13 patients and 10 aneurysms in 10 patients in; and left circumflex artery (LCX)- 13 aneurysms in 12 patients and 8 dilatations in 8 patients. Thromboses was seen in 2 patients in aneurysms of RCA, and one each in LAD and LCX. 3 patients had anomalous origin of coronary arteries (1- ALCAPA, 1- single coronary artery, 1- separate origin of LAD & LCX) which were misinterpreted as dilatations on ECHO. ECHO missed CAAs in mid/ distal segments, branches of coronaries and LCX (11-LAD, 7-RCA, 12-LCX). Thrombosis was missed in CAAs of RCA and LCX.

Radiation exposure in all children was less than 1 millisievert.

Conclusion:  In our experience, CTCA is a feasible without any need of anaesthesia and has acceptable radiation exposure. It explicitly demonstrates CAAs of KD along the entire course of coronaries and their branches. This is major advance of CTCA inasmuch as only the proximal coronaries are visualised on the latter modality.