However, it lacks optimum 3-D information and the ability to image soft tissue, making it difficult to demonstrate the spatial relationship among the coronary artery course, myocardium, and great vessels. Coronary angiography is essential to clarify the extent of the vulnerable territory of the anomalous vessel (ie, dominant versus nondominant right coronary artery, single coronary, etc). Fractional flow reserve may offer an adjunct to determine the functional significance of AAOCA narrowing or intramyocardial course of the coronary artery, although it is unproven in these settings. Congenital or Acquired Heart Disease In Kawasaki disease, to predict the progress of the disease and determine appropriate treatment and follow-up protocols, it is essential to understand the size and shape of the aneurysms in the early phase. Therefore, traditionally, invasive angiography is performed after the acute stage but, since the advent of CT and MRA invasive coronary angiography, has become second line [33]. Intravascular Ultrasound (IVUS): IVUS affords precise sequential cross-sectional imaging of the coronary lumen and coronary wall thickness with a discriminating power, based on superior spatial resolution. It is particularly useful in stenosis of the anomalous vessel in its intramural course. Arteriography Pulmonary There is no relevant literature to support the use of pulmonary arteriography in the evaluation of suspected or confirmed congenital or acquired coronary artery abnormality. CT Heart Function and Morphology Functional assessment with CT may be considered in the setting of Kawasaki disease for assessment of the consequences of coronary artery compromise. CTA Chest CTA of the chest is rarely helpful for assessment of other vascular involvement in the setting of Kawasaki disease, with axillary artery aneurysms being a common manifestation in the chest.
Congenital or Acquired Heart Disease. However, it lacks optimum 3-D information and the ability to image soft tissue, making it difficult to demonstrate the spatial relationship among the coronary artery course, myocardium, and great vessels. Coronary angiography is essential to clarify the extent of the vulnerable territory of the anomalous vessel (ie, dominant versus nondominant right coronary artery, single coronary, etc). Fractional flow reserve may offer an adjunct to determine the functional significance of AAOCA narrowing or intramyocardial course of the coronary artery, although it is unproven in these settings. Congenital or Acquired Heart Disease In Kawasaki disease, to predict the progress of the disease and determine appropriate treatment and follow-up protocols, it is essential to understand the size and shape of the aneurysms in the early phase. Therefore, traditionally, invasive angiography is performed after the acute stage but, since the advent of CT and MRA invasive coronary angiography, has become second line [33]. Intravascular Ultrasound (IVUS): IVUS affords precise sequential cross-sectional imaging of the coronary lumen and coronary wall thickness with a discriminating power, based on superior spatial resolution. It is particularly useful in stenosis of the anomalous vessel in its intramural course. Arteriography Pulmonary There is no relevant literature to support the use of pulmonary arteriography in the evaluation of suspected or confirmed congenital or acquired coronary artery abnormality. CT Heart Function and Morphology Functional assessment with CT may be considered in the setting of Kawasaki disease for assessment of the consequences of coronary artery compromise. CTA Chest CTA of the chest is rarely helpful for assessment of other vascular involvement in the setting of Kawasaki disease, with axillary artery aneurysms being a common manifestation in the chest.