Case: Rare disease ARCAPA in 1-year-old child
Clinical history
1 year old child who present with syncope. A transthoracic echocardiogram demonstrated abnormal Doppler flow near the pulmonary artery, and an anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) was suggested. A transesophageal echocardiogram further suspected ARCAPA. A coronary CT angiogram was performed for confirmation.
The CT coronary angiogram was performed using the Siemens Definition. Using 2cc/kg via a hand injection, the coronary ct angiogram was performed. The patient’s heart rate was 85BPM. The exam was performed usually a retrospective ECG gated acquisition with the Min dose setting at 30-70% of the cardiac cycle. 80kV with Care Dose 4D was used. This confirmed the diagnosis of ARCAPA.
About ARCAPA
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare coronary artery malformation. ARCAPA is diagnosed at echocardiography, usually being performed for congenital anomalies such as ASD or PDA. While it can be associated with ischemia, infarction, or heart failure ARCAPA can often be asymptomatic. Confirmation of this rare lesion is usually performed with conventional catheter angiography, and there are very few reports of using CTA to diagnose ARCAPA.
To our knowledge, this case represents the youngest child diagnosed with this disorder using Coronary CTA. The 83msec temporal resolution of dual source CT technology, in combination of aggressive dose reduction with 80kV and min dose technology enabled diagnostic non-invasive evaluation of this rare anomaly.
