Andersons pediatric cardiology 1397
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FIG.53.7 Magneticresonanceimaginginapatientwithmyocardial
infarction.(A)Thinningofthemid-tobasilarinferiorandinferolateralwalls.
(B)Lategadoliniumenhancementinthecorrespondingregionofthinning
consistentwithpriormyocardialinfarction.
UltrafastCThasbeenshowntohaveexcellentsensitivityforthedetectionof
coronaryarterystenosisinpatientswiththedisease(Fig.53.8).126Itismore
sensitivethanMRIforassessmentofdistalvesselsandthepresenceof
thrombus.Becausethetechniqueisassociatedwithrelativelyhighdosesof
ionizingradiation,itshouldbereservedforcircumstanceswhereother
noninvasivetestsareinadequate.However,newersystemsusemuchlowerdoses
ofradiation,whichcanincreasetheutilityandsafetyofthismodality.
FIG.53.8 Three-dimensionalreconstructionfromacomputed
tomographicscaninapatientwithagiantaneurysmoftherightandleft
coronaryarteries.
CoronaryAngiography
Cardiaccatheterizationandcoronaryangiographyarethegoldstandardfor
imagingagainstwhichothermethodsareassessed(Fig.53.9,Video53.2).In
additiontoprovidingbetterdelineationofthedistalcoronaryvasculature,
angiographyisthemostreliablemethodtoassesscoronaryarterystenosis(Fig.
53.10,Video53.3)orthromboticocclusion(Fig.53.11,Video53.4)andthe
presenceofcollateralvessels.Fractionalflowreservecanalsobeperformed;it
helpstoassessthepotentialforischemiaandneedforintervention.Toevaluate
whetherperipheralarteryaneurysmsarepresent,102abdominalaortographyand
subclavianarteriographyshouldbeperformedinpatientsundergoingcoronary
arteriographyforthefirsttime.Becauseselectivecoronaryangiographyposes
greaterrisksthannoninvasiveimaging,itsuseshouldberestrictedtoselected
patientswithinduciblemyocardialischemiaonnoninvasivetestingorthosein
whomnoninvasivetechniquesfailtoprovideadequatedata.Itisalsousefulafter
surgicalorpercutaneousrevascularizationtoevaluateefficacyandmonitorfor
complications(Fig.53.12,Video53.5).
FIG.53.9 Angiogramoftheleftcoronaryarteryshowingagiantaneurysm
oftheleftanteriordescendingcoronary.Thereisnoevidenceofstenosisat
theegressoftheaneurysm.Theleftmaincoronaryarteryandtheleft
circumflexcoronaryareofnormaldimensionwithnoevidenceofaneurysm
orectasia.
