Purpose or Case Report: Congenital coronary artery (CA) anomalies can be classified into abnormalities pertaining to origin, course and termination, which can serve as important prognostic factors. Some of these anomalies are asymptomatic with a benign clinical course, while others can give rise to symptoms of chest pain and even sudden death (e.g. malignant interarterial CA course). Acquired CA abnormalities such as coronary arterial aneurysms associated with Kawasaki disease may result in thrombi development, necessitating a change in patient management. Early and accurate diagnosis of these abnormalities is therefore crucial but can be technically challenging owing to the small size of the coronary arteries, rapid heart rate, and limited cooperation of children. Whilst the proximal aspect of the coronary arteries can be visualized with echocardiography, computed tomography angiography (CTA) provides a more comprehensive assessment of the coronary arteries even without ECG-triggering. Moreover, CTA offers the flexibility of customizing acquisition parameters for the individual patient. As such, CTA is rapidly becoming the imaging modality of choice for evaluating complex congenital and acquired CA abnormalities in children.

The aims of this educational exhibit are to review the embryology of coronary arteries, outline congenital and acquired CA abnormalities, and discuss the utility of optimizing low-dose CTA to evaluate these abnormalities in children. Determining the origin and course of CAs is key for pre-operative planning in some types of congenital heart disease, for example, the arterial switch procedure for transposition of great arteries and in Taussig Bing anomaly. Identifying the malignant interarterial intramural CA course can be lifesaving. Evaluating for co-existing abnormalities, such as CPAM, is also an integral part of these studies.
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