172 - CONGENITAL CORONARY ARTERY ANOMALIES ARE LIABLE TO BE MISINTERPRETED AS CORONARY DILATATIONS IN CHILDREN WITH KAWASAKI DISEASE: LESSONS LEARNED FROM CT CORONARY ANGIOGRAPHY

Background: 2D-echocardiography (2DE) has been the primary imaging modality in children with Kawasaki disease (KD) for assessment of coronary arteries. In this study, we present 3 children with KD who were diagnosed with CAAs on 2DE, CT coronary angiography (CTCA), however, showed the presence of congenital coronary artery anomalies that had been misinterpreted as CAAs.

Methods: Records of children diagnosed with KD, who underwent CTCA at our center between 2013 - 2023 were reviewed. We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA. Findings of CTCA and 2DE were compared.

Results: Of the 241 patients with KD who underwent CTCA, 3 (1.24%) had congenital coronary artery anomalies on CTCA detected incidentally. In all 3 patients, baseline 2DE had identified CAAs. CTCA was then performed for detailed evaluation as per our unit protocol. One (11-year-boy) amongst the 3 patients had complete KD, while the other two (3.3-year-boy; 4-month-girl) had incomplete KD. CTCA revealed separate origins of left anterior descending artery (LAD) and left circumflex (LCx) from left sinus [misinterpreted as dilated left main coronary artery (LCA) on 2DE], single coronary artery (interpreted as dilated LCA on 2DE] and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery. The latter patient was subsequently operated successfully.




Conclusion:

Children with KD and associated congenital anomalies of coronary arteries mandate detailed assessment on

CTCA. 2DE, alone, may not be sufficient in these circumstances. Findings on CTCA can impact therapeutic decision-making.