Cardiac magnetic resonance imaging characterizes stenosis, perfusion, and fibrosis preoperatively and postoperatively in children with anomalous coronary arteries

Abstract

Objectives: Using cardiac magnetic resonance imaging (MRI) with virtual angioscopy, we sought to evaluate coronary anatomy, myocardial injury, and left ventricular function in children with interarterial anomalous aortic origin of coronary artery before and after surgery.

Methods: We prospectively enrolled children 5 to 19 years old with interarterial anomalous coronary artery. Cardiac MRI was performed with respiratory-navigated steady-state free-precession 3-dimensional data set acquisition. Virtual angioscopy was used to evaluate the coronary ostia directly. Surgery consisted of the modified unroofing procedure.

Results: We enrolled 9 subjects between February 2009 and May 2015. Subjects were male, with an average age at surgery of 14.1 years. Anomalous coronary was right in 7 patients (77%) and left in 2. In all subjects, the proximal anomalous coronary arose tangential to the aorta with an elliptical, slitlike ostium. Before the operation, the proximal coronary artery was significantly smaller proximally than distally (2 vs 3.1 mm; P < .0001. After the operation, neo-orifices were round and patent in 7 subjects; however, 2 subjects still had narrowed neo-orifices. New postoperative MRI findings included flattened septal wall motion (N = 1), small region of midmyocardial partial-thickness scar (N = 1), and dyskinetic septal wall motion with mild aortic insufficiency (N = 1). Left ventricular function was normal both before and after surgery (P = .85).

Conclusions: Cardiac MRI with virtual angioscopy is an important tool for evaluating anomalous coronary anatomy, myocardial function, and ischemia and should be considered for initial and postoperative assessment of children with anomalous coronary arteries.

Keywords: anomalous origin of a coronary artery; cardiac magnetic resonance imaging; congenital heart disease; pediatrics.