Coronary artery imaging in grown up congenital heart disease - Complementary role of magnetic resonance and X-ray coronary angiography

Background-There is a high incidence of anomalous coronary arteries in subj ects with congenital heart disease. These abnormalities can be responsible for myocardial ischemia and sudden death or be damaged during surgical inte rvention. It can be difficult to define the proximal course of anomalous co ronary arteries with the use of conventional x-ray coronary angiography. Ma gnetic resonance coronary angiography (MRCA) has been shown to be useful in the assessment of the 3-dimensional relationship between the coronary arte ries and the great vessels in subjects with normal cardiac morphology but h as not been used in patients with congenital heart disease. Methods and Results-Twenty-five adults with various congenital heart abnorm alities were studied. X-ray coronary angiography and respiratory-gated MRCA were performed in all subjects. Coronary artery origin and proximal course were assessed for each imaging modality by separate, blinded investigators , images were then compared, and a consensus diagnosis was reached. With th e consensus readings for both magnetic resonance and x-ray coronary angiogr aphy, it was possible to identify the origin and course of the proximal cor onary arteries in all 25 subjects: 16 with coronary anomalies and 9 with no rmal coronary arteries. Respiratory-gated MRCA had an accuracy of 92%, a se nsitivity of 88%, and a specificity of 100% for the detection of abnormal c oronary arteries. The MRCA results were more likely to agree with the conse nsus for definition of the proximal course of the coronary arteries (P<0.02 ). Conclusions-For the assessment of anomalous coronary artery anatomy in pati ents with congenital heart discase, the use of the combination of MRCA with x-ray coronary angiography improves the definition of the proximal coronar y artery course. MRCA provides correct spatial relationships, whereas x-ray angiography provides a view of the entire coronary length and its peripher al run-off. Further more, respiratory-gated MRCA can be performed without b reath holding and with only limited subject cooperation.