Purpose: Although intravascular ultrasound (IVUS) in children has been reported it is not widely used due to concerns over safety. Detailed analyses of measurements outlined by the ACC consensus statement on IVUS have not been reported in children. We report our safety and analysis data to date. Procedures: IVUS of the left anterior descending was performed with mechanised pullback concurrently with surveillance coronary angiography. Procedure and fluoroscopy screening times were compared with a second group of patients who experienced coronary angiography alone. Analysis was performed to measure vessel and lumen area, vessel and lumen diameters and intimal thickness for serial slices at fixed intervals from a distal identification point. Mean atheroma burden, mean maximum intimal thickness (MIT) and overall maximal intimal thickness were determined for each study. Results: Twenty-seven procedures were analysed. Table 1 shows patient demographics and information relating to IVUS analysis. Details of procedure and fluoroscopy time for both IVUS and coronary angiography groups are presented in Table 2. No complications were encountered. Routine coronary angiography was normal in all but one patient. Conclusions: We have demonstrated the safety of IVUS for coronary surveillance in children. When compared to coronary angiography alone procedure time and screening time are increased but we feel this is outweighed by the increased sensitivity of IVUS. Fifty-two percent of children have an IMT > 0.5 mm despite normal angiography. Such detailed analysis would appear central to future research into paediatric coronary disease.