Ali TÜRK, Ulaş CAN, Özlem SAYGILI, Yusuf YALÇINBAŞ, Tayyar SARIOĞLU, Ayşe SARIOĞLU, Arda SAYGILI

Dual source multidetector computed tomography coronary angiography in the surgical planning regarding the major coronary artery anomalies in children

Amaç: Bu çalışmada, çocuklarda anormal orijin ve koroner arter fistülü gibi majör koroner anomalileri cerrahi tedavi öncesi çift kaynaklı multi dedektörlü bilgisayarlı tomografi (MDBT) koroner anjiyografi ile gösterildi. Çalışma planı: Ocak 2010 - Haziran 2011 tarihleri arasında koroner anormalliğin MDBT koroner anjiyografi ile değerlendirilmesi amacıyla kliniğimize sevk edilen toplam altı hasta (3 erkek, 3 kız; ort. yaş 6 yıl; dağılım 2 gün-15 yıl) çalışmaya dahil edildi. Tüm hastalara elektrokardiyografi (EKG) tetiklemeli çift kaynaklı MDBT koroner anjiyografi yapıldı. İşlem öncesi beta-bloker uygulanmadı. Ortalama kalp hızı 98±20 atım/dk. (dağılım 128-75 atım/dk.) idi. Tüm hastalarda koroner arterlerin ostiumları, seyirleri ve distal uçları anomaliler açısından incelendi. Fistül saptanan olgularda açılma noktası dikkatlice değerlendirildi. Çift kaynaklı MDBT incelemelerinde düşük kilovolt tekniği ile ALARA ilkeleri ile uyumlu doz azaltıcı algoritma uygulandı (80 kV, dağılım 150-350 mA). Bulgular: Üç anormal orijin (bir ALCAPA, iki sağ sinüs Valsalvadan çıkan anormal sol ana koroner arter) ve üç fistül (iki koroner-kameral fistül, bir sol ana koroner arter- koroner sinüs fistülü) çift kaynaklı MDBT ile ayrıntılı olarak gösterildi. Sonuç: Çift kaynaklı MDBT, majör koroner arter anomalilerinin veya koroner arter fistüllerinin ameliyat öncesi değerlendirmesinde konvansiyonel koroner anjiyografiye alternatif noninvaziv etkili bir yöntemdir

Çocuklarda majör koroner arter anomalilerinin cerrahi planlamas ında çift kaynaklı multi dedektör bilgisayarlı tomografi koroner anjiyografi

Background: This study aims to demonstrate major coronary artery anomalies such as anomalous origin and coronary artery fistulas on dual-source multi detector computed tomography (MDCT) coronary angiography in children before surgical treatment. Methods: Six children (3 boys, 3 girls; mean age 6 years; range 2 days to 15 years) referred for a MDCT coronary angiography for evaluation of coronary anomaly between January 2010 and June 2011 were included in this study. Electrocardiography (ECG)-gated dual-source MDCT coronary angiography was performed on all patients. No beta-blockers were given prior to the procedure. The mean heart rate was 98±20 bpm (range 128 to 75 bpm). In all patients, ostium, course, and end-distal portion of coronary artery were inspected for anomalies. Exact opening point was carefully assessed in patients with fistulas. Dual-source MDCT examination was performed with low kilovolt dose reduction algorithm (80 kV, range 150-350 mA) compatible with ALARA principles. Results: Three anomalous origin (one ALCAPA, two anomalous left main coronary artery originated from right sinus of Valsalva) and three fistulas (two coronary-cameral fistula, one left main coronary artery -coronary sinus fistula) were clearly identified with dual-source MDCT angiography. Conclusion: Dual source MDCT angiography is a noninvasive and effective method as an alternative to conventional coronary angiography for the preoperative assessment of major anomalous origin of coronary artery or coronary artery fistulas

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