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Coronary Artery Anomalies

  • Andrew M. CreanEmail author
Chapter

Abstract

Anomalies of the coronary arteries are paradoxically amongst the simplest and most difficult of subjects to get to grips with in congenital heart disease. This chapter reviews some of the commoner congenital anomalies encountered and discusses technical tips and tricks for optimal CMR imaging.

Keywords

Kawasaki Disease Cardiac Compute Tomography Steady State Free Precession Coronary Anomaly Coronary Artery Anomaly 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Movie 14.1

Example of a whole heart MRA displayed as thin sliding maximum intensity projections (MIPS) (MOV 3821 kb)

Movie 14.2

Example of a coronal free breathing scout to determine the position of the diaphragm at end-expiration for navigator placement in whole heart coronary MRA (see text) (MOV 1208 kb)

218193_1_En_14_MOESM3_ESM.mov (1.5 mb)
Movie 14.3 Example of the effect of cine frame rate (temporal resolution) on the trackability of the coronary rest period (see text). Movie 14.3 was acquired at true (segmented) temporal resolution of 50 ms. The rest periods of the right coronary artery appear relatively short and the optimal period of minimal motion may be difficult to define. Contrast with the appearance of the RCA in Movie 14.4 (MOV 1546 kb)
218193_1_En_14_MOESM4_ESM.mov (2 mb)
Movie 14.4 was acquired with a superior temporal resolution of 25 ms. In this latter example both the diastolic and systolic coronary rest periods are much easier to appreciate. At our institution we routinely acquire a single slice cine image like this with a segmented temporal resolution as high as 10 ms reconstructed over 80 phases – the tradeoff is the length of the breathhold which has to be optimized on a per patient basis and often requires the use of 4 fold acceleration factors in order to be achievable. The resulting loss of signal to noise is acceptable given that the slice is simply being used for timing of the rest period (MOV 2071 kb)
218193_1_En_14_MOESM5_ESM.mov (5.9 mb)
Movie 14.5 Retrospectively gated cardiac CT in a patient with compression of the left main coronary artery. The patient has congenitally enlarged pulmonary arteries (see text) and developed typical exertional angina which can be seen to be due to extrinsic compression of the left coronary system (MOV 6090 kb)
218193_1_En_14_MOESM6_ESM.mov (1.3 mb)
Movie 14.6 Four chamber SSFP cine demonstrating mild regional reduction in function and a mass in the left AV groove. This patient had Kawasaki’s disease as a child and was discovered to have a mass in the left AV groove corresponding to an aneurysm of the circumflex artery. The mild reduction in contractility in the lateral wall is shown in Fig. 14.14 to be due to subendocardial scar. See also Movie 14.7 (MOV 1361 kb)
Movie 14.7

Companion movie to Movie 14.6. This is the whole heart MRA examination from the patient in Movie 14.6 and Fig. 14.14. The volume stack reveals, infact, that there are 2 sequential aneurysms along the line of the circumflex artery, both containing evidence of thrombus. Note also that the inferolateral wall scar is also evident on these T1 weighted images (MOV 11171 kb)

218193_1_En_14_MOESM8_ESM.mov (9.9 mb)
Movie 14.8 A challenge for CMR in the future. This volume-rendered retrospectively-gated cardiac CT dataset is from a patient who was discovered incidentally to have an ARCAPA lesion relatively late in life (see text and Fig. 14.17). There are currently no commercially available solutions of which the author is aware that make it possible to acquire a volume data set at multiple cardiac phases by CMR for subsequent display in this format. The CT data set in this case was acquired on a 320 detector row scanner in a single heart beat with an isotropic spatial resolution of 0.5 mm. CMR offers many advantages over CT but still has some way to go before it provides this (relatively foolproof) combination of data quality and speed! (MOV 10093 kb)

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Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  1. 1.Departments of Medicine (Cardiology) & Medical ImagingPeter Munk Cardiac Center, Toronto General HospitalTorontoCanada

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