Cor Vasa 2025, 67(4):422-426 | DOI: 10.33678/cor.2025.074

Induced apnea for better CT visualization of coronary arteries in children under 1 year. And is heart rate so essential?

Marek Kardoš^a, Jana Valachová^b, Martin Fula^b, Kristián Kopáčik^b, Tomáš Hrtánek^b, Dávid Kocan^c

^a Department of Functional Diagnostics, Children's Cardiac Center, Bratislava, Slovakia

^b Department of Paediatric Anaesthesiology and Intensive Care Medicine, Children's Cardiac Center, Bratislava, Slovakia

^c Department of Diagnostic and Interventional Radiology, National Heart Institute, Bratislava, Slovakia

Background: Coronary CT angiography (CCTA) in children under one year of age is a usefull technique in visualization of coronary arteries with high spatial resolution. CT examination of children under 1 year remains a challenge for radiologists and clinicians due to radiation and motion artefacts.

Objectives: To evaluate image quality of CCTA examinations performed in children under 1 year using qualitative and quantitative parameters.

Materials and methods: A single center retrospective study of CCTA with induced apnea, performed between April 2022 and August 2024. We investigated quality of coronary arteries imaging via a visual grading analysis by two experienced radiologists.

Results: 10 CCTA examinations performed in 9 patients were included. Absent or minimal motion artifacts were seen in most of the studies (90%). The image quality was excellent in the majority of the CT examinations. The majority of patients had an image score of 1, with only 1 study receiving a score of 2. It appears that coronary artery imaging is greatly improved with apnea, according to the radiologist's experience. The heart rate does not seem to impact the visibility of coronary arteries in this patient group. The best phase for visualizing the entire course of the coronary arteries was between 30-50%. However, in 1 patient, the visibility of the left main coronary artery, left anterior descending, and circumflex artery was better in the 70-80% phase. CCTA with induced apnea was compared to 11 CCTA examinations performed before April 2022. The image quality in this earlier patient group was inferior to that of the induced apnea group. Motion artifacts were absent or minimal in 50% of the studies. Only two patients received an image score of 1; the majority of patients (6 patients) received an image score of 2, with the remaining patients receiving an image score of 3 (3 patients).

Conclusion: Coronary computed tomographic angiography with induced apnea presents a practical and efficacious imaging technique for coronary artery visualization in infants under one year of age, yielding superior image quality and detail compared to CCTA performed without induced apnea.

Keywords: Children, Coronary arteries, CT angiography, Induced apnea, Propofol

Received: February 25, 2025; Revised: June 12, 2025; Accepted: July 1, 2025; Prepublished online: June 2, 2012; Published: October 6, 2025  Show citation