Tiny Hearts, Big Challenges: Coronary Imaging in Neonates and Infants-Tiny Hearts, Big Challenges: Coronary Imaging in Neonates and Infants

Video Transcription

Video Summary

This webinar focused on coronary artery imaging in neonates and infants, a difficult area in pediatric cardiac imaging. Speakers from several children’s hospitals shared institutional approaches using CT as the main modality because of its superior spatial resolution, fast acquisition, and reduced need for sedation, though with attention to radiation dose.<br /><br />Topics included scan mode selection, coverage, IV access, contrast volume and rate, bolus timing, sedation, breath-holding, and heart-rate control. Most centers reported using retrospective ECG-gated CT routinely, while some used prospective gating for select cases. Lower-extremity IVs were preferred when possible to reduce streak artifact, and contrast was typically given at about 1.5–3 mL/kg depending on the institution and patient size.<br /><br />Sedation practices varied widely: many centers swaddle young infants and avoid anesthesia when possible, while others routinely request anesthesia, often with an LMA rather than intubation. Most institutions did not use heart-rate-controlling medications, relying instead on calming or anesthesia.<br /><br />Case examples included Kawasaki disease with aneurysms, hypoplastic left heart syndrome, pulmonary atresia with coronary sinusoids, and ALCAPA. A survey showed broad variability in practice, especially around sedation and contrast timing. The session ended with discussion of bolus tracking, test-bolus methods, and special considerations for coronary CT in very small children.

Keywords

coronary artery imaging

pediatric cardiac CT

neonates and infants

ECG-gated CT

radiation dose

contrast bolus timing

sedation practices

Kawasaki disease

ALCAPA