Evaluation of malposition of the branch pulmonary arteries using cardiovascular computed tomography angiography

A neonate with crossed pulmonary arteries: a case report and literature review of 115 cases worldwide

Malposition of the branch pulmonary arteries (MBPA) is an unusual malformation characterised by anomalous origin of both pulmonary arteries from the main pulmonary trunk. To date, only few cases have been reported. Herein, we present the first case report of a 3-day-old, full-term male neonate with the lesser form of crossed pulmonary arteries in Saudi Arabia detected by echocardiography and confirmed by cardiac CT. Crossed pulmonary arteries is not a rare anomaly, but it is a somewhat underreported anomaly, and their recognition is important because it is usually associated with other CHDs, airway obstruction, extra-cardiac anomalies, and certain genetic syndromes.

Prediction of pulmonary pressure after Glenn shunts by computed tomography-based machine learning models

OBJECTIVES

This study aimed to develop non-invasive machine learning classifiers for predicting post-Glenn shunt patients with low and high risks of a mean pulmonary arterial pressure (mPAP) > 15 mmHg based on preoperative cardiac computed tomography (CT).

METHODS

This retrospective study included 96 patients with functional single ventricle who underwent a bidirectional Glenn procedure between November 1, 2009, and July, 31, 2017. All patients underwent post-procedure CT, followed by cardiac catheterization. Overall, 23 morphologic parameters were manually extracted from cardiac CT images for each patient. The Mann-Whitney U or chi-square test was applied to select the most significant predictors. Six machine learning algorithms including logistic regression, Naive Bayes, random forest (RF), linear discriminant analysis, support vector machine, and K-nearest neighbor were used for modeling. These algorithms were independently trained on 100 train-validation random splits with a 3:1 ratio. Their average performance was evaluated by area under the curve (AUC), accuracy, sensitivity, and specificity.

RESULTS

Seven CT morphologic parameters were selected for modeling. RF obtained the best performance, with mean AUC of 0.840 (confidence interval [CI] 0.832-0.850) and 0.787 (95% CI 0.780-0.794); sensitivity of 0.815 (95% CI 0.797-0.833) and 0.778 (95% CI 0.767-0.788), specificity of 0.766 (95% CI 0.748-0.785) and 0.746 (95% CI 0.735-0.757); and accuracy of 0.782 (95% CI 0.771-0.793) and 0.756 (95% CI 0.748-0.764) in the training and validation cohorts, respectively.

CONCLUSIONS

The CT-based RF model demonstrates a good performance in the prediction of mPAP, which may reduce the need for right heart catheterization in post-Glenn shunt patients with suspected mPAP > 15 mmHg.

KEY POINTS

• Twenty-three candidate descriptors were manually extracted from cardiac computed tomography images, and seven of them were selected for subsequent modeling. • The random forest model presents the best predictive performance for pulmonary pressure among all methods. • The computed tomography-based machine learning model could predict post-Glenn shunt pulmonary pressure non-invasively.

Evaluation of Unroofed Coronary Sinus Syndrome Using Cardiovascular CT Angiography: An Observational Study

OBJECTIVE

The purpose of this study was to determine the prevalence of unroofed coronary sinus (CS) syndrome at a tertiary hospital and analyze the clinical information, cardiovascular CT angiography (CCTA) imaging findings, associated anomalies, and surgical treatment of the identified cases.

MATERIALS AND METHODS

We retrospectively searched the database of a tertiary hospital for cases of unroofed CS syndrome among patients who underwent CCTA for known or suspected congenital heart disease. After the prevalence of unroofed CS syndrome was determined, CCTA findings, associated cardiovascular abnormalities, presence or absence of airway compression, clinical information, and surgical outcome were recorded.

RESULTS

A total of 23 patients with unroofed CS syndrome were identified, with the syndrome therefore having a prevalence of 0.36% among patients with congenital heart disease who underwent CCTA. The diagnostic accuracy of CCTA for unroofed CS syndrome was 100%, whereas that of echocardiography was 69%. Type I unroofed CS syndrome was the most commonly noted type (52% of patients). All 23 patients had associated cardiovascular anomalies, including persistent left superior vena cava (65% of patients) and atrial septal defect (65%). Surgery was performed for 70% of patients because of cardiovascular anomalies. Seven patients (30%) had associated secondary airway compression but did not require surgical correction.

CONCLUSION

At our institution, the prevalence of unroofed CS syndrome was 0.36% among patients with congenital heart disease who underwent CCTA. CCTA has excellent diagnostic performance, delineating different subtypes of unroofed CS syndrome and associated cardiovascular planning for treatment of unroofed CS syndrome abnormalities, improving clinical decision making, and permitting preoperative planning for treatment of unroofed CS syndrome.

Crossed pulmonary arteries associated with single atrium in an adult: a case report

Background

Crossed pulmonary arteries or single atrium is a rare form of cardiovascular anomaly. In previous studies, the anomalies are detected in infant or early adolescence, and infrequently seen in adult population.

Case presentation

We presented a case of the coexistence of two congenital anomalies in a 44-year-old woman who remained well tolerated and undiscovered until adulthood. Physical examination showed a grade III systolic murmur at the cardiac apex, and a grade II/III systolic murmur at left 2–3 intercostal space. An echocardiography revealed absence of atrial septal tissue. Dual-source CT angiography was performed for further evaluation of the great vessel. Except an enlarged single atrium, the imaging showed that the origination of the left pulmonary artery from the pulmonary trunk was superior to that of the right pulmonary artery. The branch pulmonary arteries then crisscrossed as they coursed to their respective lungs. The findings were illustrated by the right heart catheterization and then confirmed at surgery.

Conclusions

To our knowledge, this is the first case report of crossed pulmonary arteries with single atrium as the only additional cardiac anomaly in an adult. Knowledge of this rare combination will be helpful in the differential diagnosis of congenital heart disease and assist the surgeon in treatment planning.