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Society for Pediatric Radiology – Poster Archive

Showing 9 Abstracts.

Maller Vijetha,  Maller Vinod

Final Pr. ID: Poster #: CR-004

10-year-old male presented with intermittent fever, cough, shortness of breath, and weight loss. Contrast CT chest performed showed pulmonary thrombus in the right lower lobe branch with necrotizing cavitary pneumonia of the right lower lobe. Dilation of the left coronary artery (LCA) was noted on the chest CT and hence dedicated CT coronary angiography was performed. On CT coronary angiography, there was dilation of the proximal LCA with a wide caliber fistula arising from the LCA, proximal to its bifurcation. The fistula coursed in a retroaortic manner, draining into the right atrium posteriorly at the superior cava-atrial junction. Blood culture showed HACEK organism which is known to be associated with endocarditis. The echocardiogram showed possible vegetation attached to the left side of the atrial septum. After the patient was medically treated with intravenous antibiotics, successful ligation of the fistula was performed at its insertion to the right atrium.
We will discuss in detail as well as illustrate the CT coronary angiography findings in this patient using MIP and 3D reconstructions. We will also describe the types of coronary cameral fistula in detail
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Authors:  Maller Vijetha , Maller Vinod

Keywords:  coronary cameral fistula

Gould Sharon,  Harty M.,  Ostrowski John,  Tsuda Takeshi

Final Pr. ID: Poster #: SCI-008

Diseases of the coronary arteries are rare in children, but can present as unexpected catastrophic events without preceding symptoms. It is essential to identify patients at risk to prevent potentially serious cardiovascular events. Coronary CT angiography (CCTA) has been widely studied in adults, but its clinical applications are not well established in children. Read More

Authors:  Gould Sharon , Harty M. , Ostrowski John , Tsuda Takeshi

Keywords:  Coronary, CTA, Pediatric

Salman Rida,  More Snehal,  Ferreira Botelho Marcos,  Ketwaroo Pamela,  Masand Prakash,  Molossi Silvana,  Jadhav Siddharth

Final Pr. ID: Paper #: 047

Anomalous Aortic Origin of Coronary Artery (AAOCA) is the 2nd most common cause of sudden cardiac death in the young. Coronary artery origins are evaluated as part of transthoracic echocardiography (TTE) and diagnostic precision may be limited by technical limitations, operator dependence, and patient cooperation. MRI and gated Cardiac Computed Tomographic Angiography (CCTA) are often utilized in patients where an anomaly is suspected on TTE. There is limited literature comparing TTE and CCTA in children with suspected AAOCA. The purpose of this study is to determine the distribution of various coronary anomalies comparing TTE and CCTA data, and define the added value advanced imaging brings in clinical decision-making. Read More

Authors:  Salman Rida , More Snehal , Ferreira Botelho Marcos , Ketwaroo Pamela , Masand Prakash , Molossi Silvana , Jadhav Siddharth

Keywords:  Anomalous coronaries, CT angiography, Echocardiography

Hatoum Hoda,  Krishnamurthy Rajesh,  Parthasarathy Jayanthi,  Flemister Dorma,  Mery Carlos,  Molossi Silvana,  Dasi Lakshmi Prasad

Final Pr. ID: Paper #: 043

AAOCA is the second leading cause of sudden cardiac death in the young which typically occurs with exertion. With in-vitro patient-specific modeling the study aims to assess the differences in fractional flow reserve(FFR)with hyperemia(high-flow)in a patient with AAOCA with a confirmed ischemic event and compare it to a patient with normal coronaries Read More

Authors:  Hatoum Hoda , Krishnamurthy Rajesh , Parthasarathy Jayanthi , Flemister Dorma , Mery Carlos , Molossi Silvana , Dasi Lakshmi Prasad

Keywords:  Aaoca, CT, Coronary

Tan Timothy Shao Ern,  Woon Tian Kai,  Fortier Marielle

Final Pr. ID: Poster #: EDU-007

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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Authors:  Tan Timothy Shao Ern , Woon Tian Kai , Fortier Marielle

Keywords:  Coronary artery, Computed tomography, Aneurysm

Maller Vijetha,  Boston Umar,  Knott-craig Christopher

Final Pr. ID: Poster #: CR-003

Transseptal course is defined as the anomalous course of left coronary artery (LCA) after its anomalous origin from the opposite sinus, when the coronary artery takes a sharp turn to dip into the basal interventricular septum behind the right ventricular outflow tract (RVOT) and emerge laterally to the epicardial surface. Transseptal course is generally considered by some as benign entity. However, case reports of severe cardiac symptoms such as myocardial ischemia, arrhythmia, and even sudden cardiac death have been sporadically reported. Surgical management in symptomatic patients can be challenging. One of the latest surgical approach to this anomaly is transection of the RVOT, unroofing the septal course of the LCA, followed repair of the posterior wall of the RVOT by placement of rectangular strip of autologous pericardium.
We present a 17-year-old male who was noted to have an anomalous left coronary artery on screening echocardiography. CT coronary angiography revealed anomalous origin of left anterior descending artery (LAD) from the right sinus of Valsalva with a long intraconal/transseptal course that measured 43mm in length. The left circumflex artery (LCx) also had anomalous origin from the right sinus of Valsalva with retroaortic course and a fistula with pulmonary artery. This patient had 5 ostia at the right sinus of Valsalva with separate origins of two conus arteries. This patient had successful transconal unroofing of the anomalous LAD and ligation of the LCX to pulmonary artery fistula.
We will discuss the preoperative as well as postoperative CT coronary angiography using multiplanar views, 3D hollow reconstructions, as well as virtual endoluminal views. The CT coronary angiography characteristics of transeptal course of anomalous coronary artery will be discussed in detail. Illustrations with 3D reconstructions which helped our cardiothoracic surgeons to plan the transconal unroofing of the anomalous LAD will be discussed. Recognition of transeptal course of the coronary artery and describing its course and relation to the RVOT including the assessment of the overlying conal septal myocardial thickness with the help of multiplanar views and 3D views can help better surgical planning.
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Authors:  Maller Vijetha , Boston Umar , Knott-craig Christopher

Keywords:  Transseptal course, coronary fistula, transconal unroofing

Parthasarathy Jayanthi,  Hatoum Hoda,  Flemister Dorma,  Mery Carlos,  Molossi Silvana,  Dasi Lakshmi Prasad,  Krishnamurthy Rajesh

Final Pr. ID: Paper #: 044

Morphological features including intramural course, high ostial location, and slit-like ostium are considered risk factors for sudden death in patients with AAOCA. Assessment of coronary blood flow at rest and hyperemia may contribute to understanding the cause of death, and to risk stratification and management. A patient-specific biomechanical 3D printed model incorporating morphological features derived from CTA was developed to quantify coronary blood flow in AAOCA. Read More

Authors:  Parthasarathy Jayanthi , Hatoum Hoda , Flemister Dorma , Mery Carlos , Molossi Silvana , Dasi Lakshmi Prasad , Krishnamurthy Rajesh

Keywords:  Anomalous coronary, 3D Printing, FFR

Zucker Evan,  Kino Aya,  Vasanawala Shreyas,  Newman Beverley,  Barth Richard,  Chan Frandics

Final Pr. ID: Paper #: 013

To evaluate by CCTA the prevalence and morphology of pediatric LAD MBs (coronary segments that contact or tunnel within myocardium), which are common and usually incidental in adults but only sporadically reported in children. Read More

Authors:  Zucker Evan , Kino Aya , Vasanawala Shreyas , Newman Beverley , Barth Richard , Chan Frandics

Keywords:  Myocardial Bridge, Coronary CTA, Coronary