![](bg2.png)
Figure 1: CTCA in a 21-month-old girl with ALCAPA.
Axial CT image demonstrates the left coronary artery
originates from the left pulmonary sinuse (arrow). AO =
aortic artery, PA = pulmonary artery, RCA = right
coronary artery, LAD = left anterior descending coronary
artery, LCX = left circumflex coronary artery.
Figure 2: CTCA in a 5-month-old girl with ALCAPA.
Axial CT image demonstrates the left coronary artery
originates from the left wall of the main pulmonary artery
(arrow). PA = pulmonary artery, LCA = left coronary
artery.
Figure 3: CTCA in a 4-year-old girl with ALCAPA. Axial
CT image (a) demonstrates the left coronary artery
originates from the posterior wall of the main pulmonary
artery (arrow). Volume rendering image (b) shows the
dilated right coronary artery and the tortuous collateral
vessel between the right and the left coronary artery
(arrow). AO = aortic artery, PA = pulmonary artery, LCA
= left coronary artery, RCA = right coronary artery.
4 DISCUSSION
CTCA can provide direct anatomic detail of the
coronary arteries and their origins as well as the
degree of collateralization (Cowles, 2007).
Depending on the acquired raw data, various phases
of the cardiac cycle may be available. In children
with low heart rate, images are usually reconstructed
from the diastolic phase (around 70% of the R-R
interval). But for children with heart rates >80/min,
it has been shown that the end-systolic phase
(between 35% and 45% of the R-R interval)
provides the best sharpness for the coronary arteries.
In case of cardiac motion artefacts, additional sets
may be reconstructed from other available phases of
the cardiac cycle (Lederlin, 2011).
One drawback of CTCA is the ionizing radiation.
Children have unequivocally higher radiosensitivity
and longer life expectancy than the older population
(Goo, 2012). In our study, we lowered the tube
voltage to 80-kV. The tube current was adapted to
the body weight. These settings do not impair image
quality too much and are considered sufficient for
diagnostic evaluation.
5 CONCLUSIONS
In conclusion, CTCA with a low-dose technique is a
valuable non-invasive method to show the
anomalous origin of the coronary artery in small
children with ALCAPA, especially for patients
whose origin of the left artery cannot be detected by
TTE. It is helpful to make a correct diagnosis before
surgery and lower the mortality.
REFERENCES
Paul JF., Rohnean A., Elfassy E., et al., 2011. Radiation
dose for thoracic and coronary step-and-shoot CT
using a 128-slice dual-source machine in infants and
small children with congenital heart disease. Pediatr
Radiol, 41(2):244-249.
Cowles RA., Berdon WE., 2007. Bland-White-Garland
syndrome of anomalous left coronary artery arising
from the pulmonary artery (ALCAPA): a historical
review. Pediatr Radiol, 37(9):890-895.
Lederlin M., Thambo JB., Latrabe V., et al., 2011.
coronary imaging techniques with emphasis on CT
and MRI. Pediatr Radiol, 41(12):1516-1525.
Goo HW., 2012. CT radiation dose optimization and
estimation: an update for radiologists. Korean J Radiol,
13(1):1-11.