Visualization of Anomalous Coronary Artery in the Presence of Arrhythmia Using Radial Balanced Fast Field Echo Coronary Magnetic Resonance Angiography
A 41-year-old man presented with recurrent syncope since the age of 10, along with tachyarrhythmia and angina pectoris during exercising. The patient had undergone x-ray angiography in a foreign country where a single coronary artery was seen, and he was sent to our hospital for further evaluation and therapy. Standard coronary MRA with navigator-gated free-breathing cardiac-triggered T2-prepared 3D gradient echo imaging and cartesian k-space sampling (Figure, A; Movie I) was performed, demonstrating major motion artifacts due to tachyarrhythmia (heart frequency varying between 72 and 105 bpm [mean 92]). Thus, this standard technique did not visualize the left anterior descending coronary artery. Subsequently, navigator-gated free-breathing cardiac-triggered T2-prepared 3D balanced fast field echo (FFE) (steady-state free precession) imaging with radial k-space sampling was performed, which allowed for clear visualization of the anomalous single coronary artery with the left coronary artery arising from the right sinus with a common ostium and an anomalous course of the left main coronary artery between the aorta and the pulmonary trunk (Figure, B). The proximal and middle portion of the left anterior descending coronary artery is clearly visible using radial balanced FFE coronary MRA (arrows in Figure, B, and Movie II), allowing for preoperative planning. Radial k-space sampling is known to be less sensitive to motion artifacts than cartesian k-space sampling.
Movies are available in the online-only Data Supplement at http://www.circulationaha.org.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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