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Mohata AP, Shetty H, Singh S, Gowda S, Kothari RJ, Raj V. Cardiac Computed Tomography Angiography in Infants and Young Children Without Sedation. Indian J Pediatr 2024; 91:961-963. [PMID: 38282105 DOI: 10.1007/s12098-024-05041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
Cardiac computed tomography (CT) imaging plays a pivotal role in the diagnosis and management of infants and young children with congenital heart disease (CHD). While the benefits of CT imaging are well-established, the challenge lies in adapting these procedures to the unique requirements of infants and young children. Traditionally, sedation has been a common practice to ensure cooperation and motion control during imaging. However, using sedation introduces its challenges including potential risks, limitations, and cost implications. In this study, authors explore the feasibility, safety, and diagnostic accuracy of unsedated cardiac CT examinations in infants and young children. This study proves cardiac CT can be performed in India without sedation using simple restraining techniques. This approach aligns with the cultural and familial dynamics prevalent in the country and holds the potential to address economic and infrastructure challenges.
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Affiliation(s)
- Aditya Purushottam Mohata
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bengaluru, 560099, Karnataka, India
| | - Hariprasad Shetty
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bengaluru, 560099, Karnataka, India
| | - Shuchi Singh
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bengaluru, 560099, Karnataka, India
| | - Suraj Gowda
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bengaluru, 560099, Karnataka, India
| | - Richa Jayesh Kothari
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bengaluru, 560099, Karnataka, India
| | - Vimal Raj
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bengaluru, 560099, Karnataka, India.
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Kim KM, Moon CH, Lee WJ, Kim WJ, Kim M, Jeong J, Lee HB, Jeong SM, Choi HJ, Hwang TS, Lee HC, Yu JH, Nam A, Kim DH. Surgical Correction of a Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Connections Using Cardiac Computed Tomography Imaging and a 3D-Printed Model. Animals (Basel) 2024; 14:1094. [PMID: 38612332 PMCID: PMC11010815 DOI: 10.3390/ani14071094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Sinus venosus atrial septal defects (SVASDs), concurrent with partial anomalous pulmonary venous connections (PAPVCs), are a rare congenital heart disease in dogs. Surgical correction is essential when clinical signs or significant hemodynamic changes are present. We aimed to report on the successful surgical correction of an SVASD with PAPVCs, using a computed tomography (CT)-based customized 3D cardiac model. A 10-month-old male poodle was referred for corrective surgery for an ASD. Echocardiography confirmed a hemodynamically significant left-to-right shunting flow through an interatrial septal defect and severe right-sided heart volume overload. For a comprehensive diagnosis, a CT scan was performed, which confirmed an SVASD with PAPVCs. A customized 3D cardiac model was used for preoperative decision-making and surgical rehearsal. The defect was repaired using an autologous pericardial patch under a cardiopulmonary bypass (CPB). Temporary pacing was applied for sinus bradycardia and third-degree atrioventricular block. The patient recovered from the anesthesia without further complications. The pacemaker was removed during hospitalization and the patient was discharged without complications 2 weeks post-surgery. At the three-month follow-up, there was no shunting flow in the interatrial septum and the right-sided volume overload had been resolved. The cardiac medications were discontinued, and there were no complications. This report indicates the validity of surgical correction under CPB for an SVASD with PAPVCs, and the advantages of utilizing a CT-based 3D cardiac model for preoperative planning to increase the surgical success rate.
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Affiliation(s)
- Kyung-Min Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Chang-Hwan Moon
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Won-Jong Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Woo-Jin Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Mihyung Kim
- Chungnam National University Sejong Hospital, 20 Bodeum 7-ro, Sejong-si 30099, Republic of Korea;
| | - Jaemin Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Hae-Beom Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Seong-Mok Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Ho-Jung Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea;
| | - Tae Sung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, 501 Jinju-daero, Jinju-si 52828, Republic of Korea; (T.S.H.); (H.C.L.)
| | - Hee Chun Lee
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, 501 Jinju-daero, Jinju-si 52828, Republic of Korea; (T.S.H.); (H.C.L.)
| | - Jae Hyeon Yu
- Department of Cardiothoracic Surgery, Chungnam National University Hospital, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Republic of Korea;
| | - Aryung Nam
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Dae-Hyun Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
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Reichl N, Rabl E, Shehu N, Ferrari I, Martinoff S, Wiesner G, Stern H, Ewert P, Meierhofer C. Ambulatory sedation for children under 6 years with CHD in MRI and CT. Cardiol Young 2024; 34:647-653. [PMID: 37691624 DOI: 10.1017/s1047951123003207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
INTRODUCTION In infants and young children, good image quality in MRI and CT requires sedation or general anesthesia to prevent motion artefacts. This study aims to determine the safety of ambulatory sedation for children with CHD in an outpatient setting as a feasible alternative to in-hospital management. METHODS We recorded 91 consecutive MRI and CT examinations of patients with CHD younger than 6 years with ambulatory sedation. CHD diagnoses, vital signs, applied sedatives, and adverse events during or after ambulatory sedation were investigated. RESULTS We analysed 91 patients under 72 months (6 years) of age (median 26.0, range 1-70 months; 36% female). Sixty-eight per cent were classified as ASA IV, 25% as ASA III, and 7% as ASA II (American Society of Anesthesiologists Physical Status Classification). Ambulatory sedation was performed by using midazolam, propofol, and/or S-ketamine. The median sedation time for MRI was 90 minutes (range 35-235 minutes) and 65 minutes for CT (range 40-280 minutes). Two male patients (age 1.5 months, ASA II, and age 17 months, ASA IV) were admitted for in-hospital observation due to unexpected severe airway obstruction. The patients were discharged without sequelae after 1 and 3 days, respectively. All other patients were sent home on the day of examination. CONCLUSION In infants and young children with CHD, MRI or CT imaging can be performed under sedation in an outpatient setting by a well-experienced team. In-hospital backup should be available for unexpected events.
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Affiliation(s)
- Nicolas Reichl
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Elisabeth Rabl
- Anesthesiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nerejda Shehu
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Irene Ferrari
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Stefan Martinoff
- Radiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gunther Wiesner
- Anesthesiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Heiko Stern
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Peter Ewert
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Christian Meierhofer
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Sharma A, Garg D, Naganur SH, Singhal M. Right Aortic Arch with Bicarotid Trunk and Isolated Left Subclavian Artery: Hitherto Unreported Pattern. Indian J Radiol Imaging 2023; 33:560-562. [PMID: 37811163 PMCID: PMC10556312 DOI: 10.1055/s-0043-1769502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Variant arch anatomy may be seen associated with many congenital heart diseases. Its accurate preoperative identification is of paramount importance in optimal surgical planning of such cases. This case describes one such variant arch anatomy with two vessel right aortic arch, comprising of bicarotid trunk (giving rise to bilateral common carotid arteries) and right subclavian artery with isolation of the left subclavian artery, in a patient with tetralogy of Fallot. Right aortic arch with isolated left subclavian artery has already been described in association with tetralogy of Fallot. However, to the best of our knowledge, present arch pattern consisting of right aortic arch with bicarotid trunk and isolated left subclavian artery has not been reported in literature so far. Moreover, this case highlights the utility of multidetector computed tomography in accurate identification of variant arch anatomy in addition to delineation of cardiac and extracardiac details.
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Affiliation(s)
- Arun Sharma
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Dollphy Garg
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Manphool Singhal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Appadurai V, Safdur T, Narang A. Assessment of Right Ventricle Function and Tricuspid Regurgitation in Heart Failure: Current Advances in Diagnosis and Imaging. Heart Fail Clin 2023; 19:317-328. [PMID: 37230647 DOI: 10.1016/j.hfc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Right ventricular (RV) systolic dysfunction increases mortality among heart failure patients, and therefore, accurate diagnosis and monitoring is paramount. RV anatomy and function are complex, usually requiring a combination of imaging modalities to completely quantitate volumes and function. Tricuspid regurgitation usually occurs with RV dysfunction, and quantifying this valvular lesion also may require multiple imaging modalities. Echocardiography is the first-line imaging tool for identifying RV dysfunction, with cardiac MRI and cardiac computed tomography adding valuable additional information.
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Affiliation(s)
- Vinesh Appadurai
- Bluhm Cardiovascular Institute, Northwestern University, 676 North St Clair Street Suite 19-100 Galter Pavilion, Chicago, IL 60611, USA; School of Medicine, The University of Queensland, St Lucia, QLD, 4067 Australia
| | - Taimur Safdur
- Bluhm Cardiovascular Institute, Northwestern University, 676 North St Clair Street Suite 19-100 Galter Pavilion, Chicago, IL 60611, USA
| | - Akhil Narang
- Bluhm Cardiovascular Institute, Northwestern University, 676 North St Clair Street Suite 19-100 Galter Pavilion, Chicago, IL 60611, USA.
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Elreweny EAST, Dawoud MM, Mahmoud ABS, Amin MA, Zaitoun HMAH. 320 cardiac MDCT angiography in preoperative assessment of TOF and its variants: Does it worth it? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Tetralogy of Fallot is the most common cyanotic congenital heart disease encountering a large spectrum of anatomical presentations with differing surgical approaches, and long-term outcomes ranging from ventricular septal defect with limited aortic overriding and mild pulmonary obstruction to a critical form of VSD and pulmonary atresia. TOF variants include PA/VSD, TOF/CAVC, TOF/DORV and TOF with absent pulmonary valve. Also, it may be accompanied with many associated intracardiac and extracardiac anomalies that may be of value when imaging and planning the surgical procedure.
Results
Our study included 22 cases of classic TOF, 18 with PA/VSD (12 were of type A, 5 were of type B and 1 was of type C), 3 with TOF/CAVC and 7 TOF/DORV. Sub-valvular RVOTO was detected in 94% of patients. A statistically significant difference was depicted between Echocardiography and MDCT in detecting supravalvular RVOTO, however no statistically significant difference was found in sub-valvular and valvular RVOTO detection. MDCT could efficiently characterize pulmonary arterial tree with statistically significant difference between both Echocardiography and MDCT in assessment of main, right and left pulmonary arteries with P value = 0.036,0.014 and 0.023 respectively. With calculation of Mc-Goon ratio in all patients, it was favorable (> 1.2) in 33 patients (66%). MDCT entailed 19 patients with PDA versus 15 depicted by Echocardiography and 25 MAPCAs per 11patients compared 8 MAPCAs per 7 patients detected by Echocardiography. Right sided aortic arch was found in 10 patients and 24 patients showed abnormal branching pattern. Coronary artery abnormalities were identified in eight patients. MDCT showed 100% sensitivity and 100% specificity in depicting aortic, coronary and other associated extracardiac vascular anomalies.
Conclusion
MDCT offers comprehensive anatomical assessment of TOF, and its variants providing superiority over echocardiography and comparable results to cardiac catherization with 100% sensitivity and specificity in evaluation of associated extracardiac vascular anomalies as well as pulmonary arteries characterization. It is worth using MDCT routinely in combination with echocardiography for the preoperative assessment of TOF and its variants representing a less invasive option than conventional catherization with lower radiation exposure.
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Semalti K, Sharma V, Kumar V, Aneja S, Simalti AK, Malik A. Dual phase multidetector computed tomography angiography in evaluation of pulmonary arteries and collateral vessels in children with cyanotic congenital heart diseases. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Spanaki A, Kabir S, Stephenson N, van Poppel MPM, Benetti V, Simpson J. 3D Approaches in Complex CHD: Where Are We? Funny Printing and Beautiful Images, or a Useful Tool? J Cardiovasc Dev Dis 2022; 9:269. [PMID: 36005432 PMCID: PMC9410138 DOI: 10.3390/jcdd9080269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Echocardiography, CT and MRI have a crucial role in the management of congenital heart disease (CHD) patients. All of these modalities can be presented in a 2D or a 3D rendered format. The aim of this paper is to review the key advantages and potential limitations, as well as the future challenges of a 3D approach in each imaging modality. The focus of this review is on anatomic rather than functional assessment. Conventional 2D echocardiography presents limitations when imaging complex lesions, whereas 3D imaging depicts the anatomy in all dimensions. CT and MRI can visualise extracardiac vasculature and guide complex biventricular repair. Three-dimensional printed models can be used in depicting complex intracardiac relationships and defining the surgical strategy in specific lesions. Extended reality imaging retained dynamic cardiac motion holds great potential for planning surgical and catheter procedures. Overall, the use of 3D imaging has resulted in a better understanding of anatomy, with a direct impact on the surgical and catheter approach, particularly in more complex cases.
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Affiliation(s)
- Adriani Spanaki
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - Saleha Kabir
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - Natasha Stephenson
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
| | - Milou P. M. van Poppel
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
| | - Valentina Benetti
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - John Simpson
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
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Akbar A, Hussain I, Wazir HD, Rehman Y, Ilyas S, Khan S, Ahmed T, Khan AM, Ullah I, Afridi A. Pattern of Vascular Anomalies Associated With Sinus Venosus Atrial Septal Defect. Cureus 2022; 14:e21892. [PMID: 35273854 PMCID: PMC8901160 DOI: 10.7759/cureus.21892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To evaluate children with sinus venosus atrial septal defect (SV-ASD) for associated vascular anomalies. Methodology A total of 72 children with sinus venosus atrial septal defect with partial anomalous pulmonary venous return who presented to pediatric cardiology unit, Lady Reading Hospital Peshawar, from January 2019 till June 2021 were included in this cross-sectional study. Diagnosis of sinus venosus atrial septal defect was confirmed through two-dimensional (2D) and Doppler echocardiography performed by a pediatric cardiologist. Cardiac CT angiography was performed and assessed by a pediatric cardiac interventionist and radiologist. Patients were managed according to standard protocols and guidelines. The data were entered and analyzed with Statistical Package for the Social Sciences (SPSS) version 20. Percentages were used to express frequencies. Results Mean age was 8.3 ± 2.7 years (interquartile range (IQR): two months to 18 years). There were 37 (51.4%) male and 35 (48.6%) female patients. Out of 72 patients, 64 (88.8%) patients had superior sinus venosus atrial septal defect, while inferior sinus venosus atrial septal defect was found in eight (11.1%) patients. In six (8.3%) patients, associated secundum atrial septal defect was identified. Bilateral superior vena cava was found in seven (9.7%) patients. Left aortic arch was seen in 70 (97.2%) patients, whereas two (2.7%) patients had right aortic arch. Conclusion Sinus venosus ASD is a rare type of atrial septal defect which is also associated with both pulmonary and systemic vascular anomalies. Diagnosing these vascular anomalies is of paramount importance before any corrective intervention can be done. Recognizing the pattern of these anomalies should be known to every interventional cardiologist, radiologist, and cardiac surgeon. Echocardiography alone is not a good tool to assess these extracardiac structures. Imaging modalities like CT angiography and MRI have refined our preoperative workup which is essential for the ultimate outcome of the corrective intervention.
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Nordjoe YE, Aubin Igombe SR, Chat L. Non-cardiovascular findings on chest CT angiography in children with congenital heart disease: How important are they? BMC Med Imaging 2022; 22:13. [PMID: 35065612 PMCID: PMC8783999 DOI: 10.1186/s12880-022-00739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background There are only a few publications about the non-cardiovascular findings in children with congenital heart diseases explored by chest CT angiography. The purpose of our study is to evaluate the prevalence of non-cardiovascular findings on chest CT angiographies in children with congenital heart disease and to raise awareness about their importance among the radiologists. Methods We retrospectively reviewed the 272 chest CT angiographies performed in our pediatric radiology department between January 2017 and march 2021 and extracted the data of the 180 patients positive for a congenital heart disease. Then from that pool, we sorted out the non-cardiovascular findings into significant and non-significant in regard of their relevance or not in the patient’s management. Results Non-cardiovascular lesions were found in 58% (105/180) of our patients, and 49% (88/180) of them presented at least one significant non-cardiac lesion. Lung and airways abnormalities were found in 41% (74/180) of the cases, representing the majority of the non-cardiovascular findings. Syndromic associations were found in 17% (28/180) of our patients, including 14 cases of heterotaxic syndrome. Conclusion Non-cardiovascular findings are common in children with congenital heart disease. Reporting these associated lesions is a requisite for an optimal therapeutic management of these children. Radiologists should never forget that a Chest CT angiography in children is first and foremost a chest CT.
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Romeih S, Kaoud A, Hashem M, Abdelfattah M, Gibreel M, Elzoghby M, Shaaban M, Mozy WE. A quantitative assessment of aorta root rotation in patients with tetralogy of Fallot evaluated by MSCT. Sci Rep 2021; 11:14336. [PMID: 34253813 PMCID: PMC8275787 DOI: 10.1038/s41598-021-93814-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 06/22/2021] [Indexed: 11/09/2022] Open
Abstract
Lack of conal rotation and conal malseptation is a characteristic anatomical feature for TOF which lead to dextroposed position of aorta and significant RVOT narrowing. The quantitative assessment of these anatomical features using modern cardiac imaging modality has been rarely discussed in the literature. All TOF scanned had in our center from 2013 till 2019 were included. The angle of aortic root rotation was recorded by measuring the angle between a line connecting the midpoint of the non-coronary sinus to the anterior commissure and another line along the interatrial septum. Rotation angles were correlated with proximal main pulmonary artery (MPA) size indexed to BSA. 287 TOF patients were included, 258 patients (91%) had TOF with pulmonary stenosis (TOF-PS) including 138 male (54%), median age 2 years (2 months-40 years), and 29 patients (9%) had TOF with pulmonary atresia (TOF-PA) including 17 male (59%), median age 5 years (1 m-33 years). The whole cases demonstrated clockwise rotation of the aortic root. The mean rotation angle in TOF-PS group was 52.6 ± 20.9° and in TOF-PA group was 64.9 ± 13.9°. Proximal MPA diameter was 11.1 ± 5.9 mm/m2. There was a significant negative correlation between aortic root rotation angle and proximal MPA diameter (r = - 0.262, P = 0.000). The rotation angle of aortic root was significantly higher in TOF-PA compared to TOF-PS (64.9 ± 13.9° vs. 52.6 ± 20.9°, P = 0.001, respectively). MSCT provide a quantitative measurement methodology of conal malseptation and its effect in TOF patients. There is a clockwise rotation angle of the aortic root in TOF patients that correlates negatively with proximal MPA size. TOF-PA have a larger rotation angle of aortic root.
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Affiliation(s)
- Soha Romeih
- Department of Radiology, Aswan Heart Centre, Kasser Elhagar Street, P.O Box 81512, Aswân, Egypt.
- Department of Cardiology, Tanta University, Tanta, Egypt.
| | - Alaa Kaoud
- Department of Anatomy and Embryology, Aswan University, Aswan, Egypt
| | - Mohamed Hashem
- Department of Anatomy and Embryology, Assiut University, Asyût, Egypt
| | - Mohamed Abdelfattah
- Department of Radiology, Aswan Heart Centre, Kasser Elhagar Street, P.O Box 81512, Aswân, Egypt
- Department of Radiology, Al-Azhar University, Cairo, Egypt
| | - Mohamed Gibreel
- Department of Radiology, Aswan Heart Centre, Kasser Elhagar Street, P.O Box 81512, Aswân, Egypt
| | - Mohamed Elzoghby
- Department of Radiology, Aswan Heart Centre, Kasser Elhagar Street, P.O Box 81512, Aswân, Egypt
- Department of Cardiology, Tanta University, Tanta, Egypt
| | - Mahmoud Shaaban
- Department of Radiology, Aswan Heart Centre, Kasser Elhagar Street, P.O Box 81512, Aswân, Egypt
- Department of Cardiology, Tanta University, Tanta, Egypt
| | - Wesam El Mozy
- Department of Radiology, Aswan Heart Centre, Kasser Elhagar Street, P.O Box 81512, Aswân, Egypt
- Department of Radiology, Cairo University, Cairo, Egypt
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Sreedher G, Bruckman D, Ganapathy SS. 320 Slice CT in Imaging of Congenital Heart Diseases in Infants: A Single-Center Experience. Cureus 2021; 13:e13348. [PMID: 33754089 PMCID: PMC7971719 DOI: 10.7759/cureus.13348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective The study was conducted to evaluate the best possible imaging technique for neonatal cardiac imaging including optimal injection techniques, intravenous line placement, expected radiation dose, and need for sedation while performing the study on a 320 slice Toshiba® Aquilion ONE® scanner. Study results can be used to optimize imaging parameters for maximum clinical yield. We provide representative images of our cases. Methodology Cardiac CTs performed on infants less than one year of age at the time of study were evaluated. Data collection included radiation dose, duration of the scan, heart rate, type and route of contrast injection, need for sedation or general anesthesia and quality of study including image contrast and motion artifacts. Results Average age of infants at the time of scan was approximately two months. Prospectively gated volumetric scans performed within one heartbeat with a single gantry turn formed the majority of studies. Average effective dose was below 1 mSv. Several patients were scanned without any sedation. Most studies were deemed diagnostic and of superior quality on a 4-point scale. Qualitative image analysis revealed an excellent intraclass correlation between two raters. Conclusion Parameters needed for successfully performing cardiac CTs with a high degree of diagnostic quality in neonates were identified. For infants below a year hand injection of Isovue 300 in a 24 G peripheral upper extremity IV line with real-time contrast bolus monitoring and manual start to scanning is adequate when being scanned on a 320 slice Volumetric scanner with prospective auto-target EKG gating. Sedation may not be necessary for infants when wrap and feed techniques and free breathing are employed. Radiation doses utilizing this technique were uniformly low.
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Affiliation(s)
| | - David Bruckman
- Statistics, Biostatistical Solutions, LLC, Cleveland, USA
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13
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Pediatric Cardiac CT and MRI: Considerations for the General Radiologist. AJR Am J Roentgenol 2020; 215:1464-1473. [PMID: 33084361 DOI: 10.2214/ajr.19.22745] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Ali SA, Amin DH, Khattab RT. Intermodality agreement between TTE and low kVp ECG-gated MDCTA in diagnosis of complex CHD in pediatrics. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Transthoracic echocardiography (TTE) is considered the primary diagnostic modality in congenital heart disease (CHD). However, it has limited role in evaluation of extra-cardiac major vessels abnormalities. Cardiac catheterization angiography is considered the gold standard investigation, yet, it is invasive. The aim of this study is to evaluate the agreement between TTE and low kVp ECG-gated cardiac multi-detector CT angiography (MDCTA) in detecting cardiac and extra-cardiac findings of complex congenital heart disease in a sample size of 36 patients (19 males and 17 females) with an age ranged between 30 days and 12 years (mean age 25.5 months). All cases were diagnosed to have complex CHD clinically and by TTE then referred to undergo cardiac low kVp ECG-gated MDCTA to confirm diagnosis and for better assessment of extra-cardiac major vessels abnormalities. Data derived from both modalities were then compared to calculate the inter-technique variability by using Cohen’s kappa statistics.
Results
TTE diagnosed 96% of intra-cardiac anomalies and only 54% of extra-cardiac major vessels anomalies detected by MDCTA, with variable degrees of intermodality agreement in detection different anomalies ranging between perfect agreement in diagnosing most of intra-cardiac lesions and very poor agreement in diagnosing extra-cardiac SVC anomalies.
Conclusion
Low kVp ECG-gated cardiac MDCTA is a rapid, non-invasive and reliable diagnostic modality in complex congenital heart diseases. It confirms TTE findings in intra-cardiac anomalies and significantly surpasses TTE reliability in diagnosis of extra-cardiac major vessels anomalies. So, it is indispensable as part of adequate preoperative assessment algorithm in cases of complex CHD and can't be replaced by TTE even with the later providing accurate assessment of intra-cardiac anomalies.
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Ciancarella P, Ciliberti P, Santangelo TP, Secchi F, Stagnaro N, Secinaro A. Noninvasive imaging of congenital cardiovascular defects. Radiol Med 2020; 125:1167-1185. [PMID: 32955650 DOI: 10.1007/s11547-020-01284-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 12/19/2022]
Abstract
Advances in the treatment have drastically increased the survival rate of congenital heart disease (CHD) patients. Therefore, the prevalence of these patients is growing. Imaging plays a crucial role in the diagnosis and management of this population as a key component of patient care at all stages, especially in those patients who survived into adulthood. Over the last decades, noninvasive imaging techniques, such as cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT), progressively increased their clinical relevance, reaching stronger levels of accuracy and indications in the clinical surveillance of CHD. The current review highlights the main technical aspects and clinical applications of CMR and CCT in the setting of congenital cardiovascular abnormalities, aiming to address a state-of-the-art guidance to every physician and cardiac imager not routinely involved in the field.
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Affiliation(s)
- Paolo Ciancarella
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Paolo Ciliberti
- Pediatric Cardiology and Pediatric Cardiac Surgery Department, Bambino Gesù Children's Hospital IRCSS, Rome, Italy
| | - Teresa Pia Santangelo
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Francesco Secchi
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy
| | - Nicola Stagnaro
- Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Aurelio Secinaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
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16
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Raptis DA, Bhalla S. Current Status of Cardiac CT in Adult Congenital Heart Disease. Semin Roentgenol 2020; 55:230-240. [PMID: 32859340 DOI: 10.1053/j.ro.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Mediastinal mass after a Blalock-Taussig shunt: utility of CT angiography. Cardiol Young 2020; 30:722-723. [PMID: 32340649 DOI: 10.1017/s1047951120000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pseudoaneurysms are rare complications of Blalock-Taussig fistulas. We present the case of an abscessed right pulmonary aneurysm after a Blalock-Taussig fistula in the context of a Salmonella bacteremia.
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18
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Dydynski PB, Austin JS, Kozik D, Alsoufi B. Utility of Pre- and Postoperative Computed Tomography Angiography for the Evaluation of a Complex Vascular Ring. World J Pediatr Congenit Heart Surg 2019; 10:654-656. [PMID: 31496408 DOI: 10.1177/2150135119867586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present the case of a neonate born with an unusual complex vascular ring formed by a left-sided aortic arch that had retroesophageal course to join a right-sided descending aorta and a very large right-sided arterial ductus from the right pulmonary artery to the descending aorta. Associated finings included aortic arch hypoplasia, aberrant right subclavian artery, and aberrant origin of the left pulmonary artery from the aorta. We focus on the role of computed tomography angiography in the preoperative and postoperative assessment of this complex anomaly.
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Affiliation(s)
- Philip B Dydynski
- Department of Radiology, Norton Children's Hospital, Louisville, KY, USA
| | - John S Austin
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Deborah Kozik
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Bahaaldin Alsoufi
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA
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19
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Alam T, Munir MK, Hamidi H. Congenital heart disease frequency in children undergoing MDCT angiography; a 4-year tertiary care hospital experience from Kabul, Afghanistan. BJR Open 2019; 1:20180032. [PMID: 33178923 PMCID: PMC7592430 DOI: 10.1259/bjro.20180032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/04/2019] [Accepted: 06/24/2019] [Indexed: 12/01/2022] Open
Abstract
Objectives: Echocardiography and cardiac angiography are two main imaging modalities used for evaluating congenital heart diseases (CHDs). Evaluation of CHDs is now possible with Multidetector CT (MDCT) angiography in Afghanistan. To the best of researchers' knowledge, no published data is available on frequency of CHDs among children undergoing chest MDCT angiography in Afghanistan; hence, this study is first of its nature to be conducted in this context. To describe the frequency of CHDs among children who underwent chest MDCT angiography in radiology department at French Medical Institute for Mothers and Children (FMIC) from April 2010 to July 2014. Methods & materials: A retrospective, cross-sectional descriptive study was conducted at radiology department FMIC in Kabul, Afghanistan. The study population consisted of all paediatric patients (aged 1 day–17 years) who underwent chest MDCT angiography at radiology department FMIC from April 2010 to July 2014. All examinations were performed in arterial phase by 128 slice Siemens scanner after intravenous administration of non-ionic water-soluble contrast material (Omnipaque 350) at a volume of 2 ml/Kg. CT setup included non-electrocardiogram gated CT, CT dose index 5–10 and dose–length product 120–200, with post-processing following initial scan. CT reports were reviewed from Radiology Information System. Data collection tool was developed and data were analysed using SPSS v. 22. Frequencies and proportion were calculated for various CHDs. Results: A total of 942 cases of contrast enhanced chest MDCT examinations were performed during this period. Out of these, 212 cases with CHDs were recruited, from which 29 cases were excluded because of undergoing previous surgical procedures or had incomplete CT reports. Remaining 183 cases (n = 183) of CHDs were included for further analysis. A total of 107 patients (58.5%) were male and 76 (41.5%) were female. The patients aged 1 day–17 years (mean age 4.47 + 4.76 standard deviation). A total of 87 patients (47.5%) had solitary anomalies while 96 patients (52.5%) had more than one defect. In terms of location, 20 cases (10.9%) were isolated intracardiac anomalies, 116 cases (63.4%) were isolated extracardiac anomalies and 47 cases (25.7%) had mixed intra- and extracardiac anomalies. Conclusion: Given the frequency, it is clear that CHDs is a complex health problem in Afghan paediatric population. MDCT angiography can be considered as a non-invasive, readily available diagnostic tool in evaluation of complex cardiac anomalies after initial evaluation. Advances in knowledge: MDCT evaluation of CHD as an alternative to echo/angiography has become more important in a country where there is severe shortage of interventional cardiologists.
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Affiliation(s)
- Tariq Alam
- Saidu Medical College, Saidu Teaching Hospitals, Swat, Pakistan
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20
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Hassanien OA, El-Shafey KI, Khedr RA, Elsheikh RG. Role of 320-MDCT in assessment of cardiac great arteries anomalies. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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21
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Mukherjee D, Nedungadi S. Shadow over abdomen. BMJ Case Rep 2018; 2018:bcr-2018-226024. [PMID: 30097550 DOI: 10.1136/bcr-2018-226024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Ntsinjana HN, Tann O, Hughes M, Derrick G, Secinaro A, Schievano S, Muthurangu V, Taylor AM. Utility of adenosine stress perfusion CMR to assess paediatric coronary artery disease. Eur Heart J Cardiovasc Imaging 2018; 18:898-905. [PMID: 27461210 DOI: 10.1093/ehjci/jew151] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/28/2016] [Indexed: 12/30/2022] Open
Abstract
Aims Cardiovascular magnetic resonance (CMR), using adenosine stress perfusion and late-gadolinium enhancement (LGE), is becoming the 'gold standard' non-invasive imaging modality in the assessment of adults with coronary artery disease (CAD). However, despite its proved feasibility in paediatric patients, clinical utility has not been demonstrated. Therefore, this study aims to establish the role of adenosine stress perfusion CMR as a screening test in paediatric patients with acquired or congenital CAD. Methods and results A total of 58 paediatric patients underwent 61 consecutive clinically indicated coronary artery assessments for diagnostic and clinical decision-making purposes. The diagnosis was based on X-ray or computed tomography coronary angiography for anatomy, adenosine stress CMR imaging for myocardial perfusion and LGE for tissue characterization. Two studies were aborted because of unwanted side effects of adenosine stress, thus 59 studies were completed in 56 patients [median age 14.1 years (interquartile range 10.9-16.2)]. When compared with coronary anatomical imaging, adenosine stress perfusion CMR performed as follows: sensitivity 100% (95% confidence interval, CI: 71.6-100%), specificity 98% (95% CI: 86.7-99.9%), positive predictive value (PPV) 92.9% (95% CI: 64.2-99.6%), and negative predictive value 100% (95% CI: 89.9-100%). Conclusion In paediatric CAD, adenosine stress perfusion CMR imaging is adequate as an initial, non-invasive screening test for the identification of significant coronary artery lesions, with anatomical imaging used to confirm the extent of the culprit lesion.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK.,Deparetment of Paediatrics, Paediatric Cardiology Division, CH Baragwanath Academic Hospital and University of the Wiwatersrand, Johannesburg, South Africa
| | - Oliver Tann
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Marina Hughes
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Graham Derrick
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Aurelio Secinaro
- Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
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23
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Rehman R, Marhisham MC, Alwi M. Stenting the complex patent ductus arteriosus in tetralogy of Fallot with pulmonary atresia: challenges and outcomes. Future Cardiol 2018; 14:55-73. [DOI: 10.2217/fca-2017-0053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Patent ductus arteriosus (PDA) stenting has gained acceptance for palliation in cyanotic congenital heart disease. The PDA in tetralogy of Fallot with pulmonary atresia (ToF-PA) arises, in the left aortic arch, from underneath the arch and connects to the proximal left pulmonary artery, often resulting in stenosis. The PDA is usually elongated and tortuous, making stent implantation challenging. Shorter duration of palliation, aggravation of branch pulmonary artery stenosis resulting in poor growth and difficulty at surgery makes ductal stenting controversial. Access via the carotid and axillary artery reduces complexity of the procedure and improves success, with recent data demonstrating good pulmonary artery growth. Advances in bioresorbable stents offer future promise and will likely resolve some controversies surrounding PDA stenting in ToF-PA.
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Affiliation(s)
- Rizwan Rehman
- Department of Pediatric Cardiology, Institut Jantung Negara (National Heart Institute) 50400 Kuala Lumpur, Malaysia
| | - Mood Che Marhisham
- Department of Pediatric Cardiology, Institut Jantung Negara (National Heart Institute) 50400 Kuala Lumpur, Malaysia
| | - Mazeni Alwi
- Department of Pediatric Cardiology, Institut Jantung Negara (National Heart Institute) 50400 Kuala Lumpur, Malaysia
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24
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Hu BY, Shi K, Deng YP, Diao KY, Xu HY, Li R, Yang ZG, Guo YK. Assessment of tetralogy of Fallot-associated congenital extracardiac vascular anomalies in pediatric patients using low-dose dual-source computed tomography. BMC Cardiovasc Disord 2017; 17:285. [PMID: 29202750 PMCID: PMC5715549 DOI: 10.1186/s12872-017-0718-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/21/2017] [Indexed: 02/05/2023] Open
Abstract
Background To investigate the diagnostic value of dual-source computed tomography (DSCT) in the evaluation of tetralogy of Fallot (TOF)-associated extracardiac vascular abnormalities in pediatric patients compared with transthoracic echocardiography (TTE). Methods One hundred and twenty-three pediatric patients diagnosed with TOF were included in this retrospective study. All patients underwent DSCT and TTE preoperatively. All associated extracardiac vascular abnormalities and their percentages were recorded. The diagnostic performances of DSCT and TTE were compared based on the surgical results. The image quality of DSCT was rated, and the effective radiation dose (ED) was calculated. Results A total of 159 associated extracardiac vascular deformities were confirmed by surgery. Patent ductus arteriosus (36, 22.64%), right-sided aortic arch (29, 18.24%), and pulmonary valve stenosis (23, 14.47%) were the most common associated extracardiac vascular abnormalities. DSCT was superior to TTE in demonstrating associated extracardiac anomalies (diagnostic accuracy: 99.13% vs. 97.39%; sensitivity: 92.45% vs. 77.07%; specificity: 99.81% vs. 99.42%). The agreement on grading the image quality of DSCT was excellent (κ = 0.80), and the mean score of the image quality was 3.39 ± 0.50. The mean ED of DSCT was 0.86 ± 0.47 mSv. Conclusions Compared to TTE, low-dose DSCT has high diagnostic accuracy in the depiction of associated extracardiac vascular anomalies in pediatric patients with TOF, and could provide more morphological details for surgeons.
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Affiliation(s)
- Bi-Yue Hu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Yu-Ping Deng
- Department of Radiology, The Medical Centre Hospital of Qionglai City, 172# Xinlin Road, Qionglai, Chengdu, Sichuan, 611530, China
| | - Kai-Yue Diao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Hua-Yan Xu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Rui Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan, 610041, China
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25
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Enaba MM, Hasan DI, Alsowey AM, Elsayed H. Multidetector Computed Tomography (CT) in Evaluation of Congenital Cyanotic Heart Diseases. Pol J Radiol 2017; 82:645-659. [PMID: 29657630 PMCID: PMC5894010 DOI: 10.12659/pjr.903222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/03/2017] [Indexed: 11/09/2022] Open
Abstract
Background The aim of the study is to emphasize the role of 128 MSCT angiography in the diagnosis of congenital cyanotic heart diseases. Material/Methods This study included sixty patients and was conducted from December 2014 to July 2016 in the Multidetector CT unit of Zagazig University hospitals. All images included axial, MPR, MIP, and VRT and were interpreted in one session. Pulmonary veins were assessed for PAPVR or TAPVR, PDA, cardiac apex and heart chambers, interatrial or interventricular septal defects, pericardium, and site and size of the great veins (IVC and SVC). Results This study included 60 patients. Thirty-four were boys (56.7%), and 26 were girls (43.3%). The age ranged from nine months to five years, and the mean age was 34.5 months. We found the following anomalies: tetralogy of Fallot (15 patients, 25%), tricuspid atresia (12 patients, 20%), Ebstein's anomaly (4 patients, 6.5%), pulmonic atresia or stenosis (7 patients, 11.5%), truncus arteriosus (6 patients, 10%), TGA (10 patients, 17%), and TAPVR (6 patients, 10%). Conclusions MDCT proved to be an important modality for decision-making in patients with congenital cyanotic heart diseases.
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Affiliation(s)
- Moanes M Enaba
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | - Doaa I Hasan
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | - Ahmed M Alsowey
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | - Hany Elsayed
- Department of Pediatrics, Zagazig University, Zagazig, Egypt
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Kumar I, Bhatia A, Sodhi KS, Khandelwal N. Partial anomalous hepatic venous drainage into left-sided atrium with right isomerism: A case report with review of literature. Indian J Radiol Imaging 2017; 27:177-180. [PMID: 28744078 PMCID: PMC5510315 DOI: 10.4103/0971-3026.209208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Right isomerism, also known as Ivemark syndrome, is an unusual degree of symmetry of some of the abdominothoracic viscera reflecting bilateral right-sidedness. We report an exceedingly rare occurrence of anomalous drainage of the left hepatic vein to the left-sided atrium in a patient of right isomerism. With this case report, we further endorse that the isomerism of atrium might extend beyond the appendages, a view that has been long dismissed by the existing literature.
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Affiliation(s)
- Ishan Kumar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- GE Radiology Section, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit S Sodhi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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27
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Shehata S, Zaiton F, Abo Warda M, Shahbah D, Ebrahim B. Value of MDCT as a non- invasive modality in evaluation of pediatric congenital cardiovascular anomalies. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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28
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Malik A, Hellinger JC, Servaes S, Schwartz MC, Keller MS, Epelman M. Prevalence of non-cardiovascular findings on CT angiography in children with congenital heart disease. Pediatr Radiol 2017; 47:267-279. [PMID: 27924361 DOI: 10.1007/s00247-016-3742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/30/2016] [Accepted: 10/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND CT angiography is gaining broader acceptance in the evaluation of children with known or suspected congenital heart disease. These studies include non-cardiovascular structures such as the mediastinum, lung parenchyma and upper abdominal organs. It is important to inspect all these structures for potential abnormalities that might be clinically important and, in some cases, may impact care plans. OBJECTIVE To determine the prevalence of non-cardiovascular findings in CT angiography of children with congenital heart disease. MATERIALS AND METHODS During 28 months, 300 consecutive children (170 males; mean age: 7.1 years, age range: 6 h-26 years), referred from a tertiary pediatric cardiology center, underwent clinically indicated CT angiography to evaluate known or suspected congenital heart disease. Slightly more than half (n = 169) of the patients were postoperative or post-intervention. Examinations were retrospectively reviewed, and non-cardiovascular findings were recorded and tabulated by organ system, congenital heart disease and operative procedure in conjunction with outcomes from medical charts. RESULTS Non-cardiovascular findings were identified in 83% (n = 250 / 300) of the studies for a total of 857 findings. In 221 patients (n = 73.7% of 300) a total of 813 non-cardiovascular findings were clinically significant, while in 9.7% (n = 29 / 300) of patients, 5.1% (n = 44 / 857) of the findings were nonsignificant. In 38.3% (n = 115 / 300) of patients with significant non-cardiovascular pathology, the findings were unexpected and directly impacted patient care plans. Commonly involved organs with non-cardiovascular findings were the lungs with 280 non-cardiovascular findings in 176 / 300 (58.7%) of patients, the airway with 139 non-cardiovascular findings in 103 / 300 (34.3%) of patients and the liver with 108 non-cardiovascular findings in 72 / 300 (24.0%) of patients. Syndromic associations were noted in 22% (n = 66 / 300) of the patients. CONCLUSION Non-cardiovascular findings are common in children with congenital heart disease who undergo CT angiography. Based upon our study population, if a child with congenital heart disease has a CT angiography, five out of six will have non-cardiovascular findings, while nearly three out of four (73.7%; 221 / 300) will have significant non-cardiovascular findings. Close attention to the non-cardiovascular structures in children with congenital heart disease presenting for a CT angiography is recommended as in nearly 40% of these children, findings were unexpected and directly altered patient care.
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Affiliation(s)
- Archana Malik
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Radiology, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Jeffrey C Hellinger
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,New York Cardiovascular Institute at Lenox Hill Radiology, New York, NY, USA
| | - Sabah Servaes
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mathew C Schwartz
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Sanger Heart and Vascular Institute, Levine Children's Hospital, Charlotte, NC, USA
| | - Marc S Keller
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Monica Epelman
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL, 32827, USA.
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Rajiah P, Saboo SS, Abbara S. Role of CT in Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:6. [DOI: 10.1007/s11936-017-0503-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Dydynski PB, Kiper C, Kozik D, Keller BB, Austin E, Holland B. Three-Dimensional Reconstruction of Intracardiac Anatomy Using CTA and Surgical Planning for Double Outlet Right Ventricle: Early Experience at a Tertiary Care Congenital Heart Center. World J Pediatr Congenit Heart Surg 2017; 7:467-74. [PMID: 27358302 DOI: 10.1177/2150135116651399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/16/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although transthoracic echocardiography (TTE) routinely establishes the diagnosis of double outlet right ventricle (DORV), it can be suboptimal for depicting exact ventricular septal defect (VSD) position, especially with respect to the outflow tracts. Advanced imaging with computed tomography angiography (CTA) can help visualize structures and relationships not easily seen by echo. Using computer-aided design, we have the ability to create three-dimensional (3D) models of the intracardiac anatomy, which can be helpful for better depicting the overall anatomy to assist surgical planning. METHODS Patients with a diagnosis of DORV were retrospectively reviewed at our institution from October 2013 to April 2015. Patients who preoperatively underwent both TTE and CTA with 3D reconstruction of the intracardiac anatomy were included. Computed tomography angiography findings with 3D intracardiac model creation were compared to the surgical findings. RESULTS Twenty-five patients underwent surgical repair of DORV during the study period. Five patients had CTA with 3D reconstruction, in addition to the standard TTE images, and were included in the study. In all five cases, CTA with 3D reconstruction of the intracardiac anatomy accurately depicted the VSD position relative to important adjacent structures, including the outflow tracts. CONCLUSION Three-dimensional reconstruction of the intracardiac anatomy using CTA data can provide accurate data for presurgical planning of DORV repair and has the potential for being especially useful in patients for whom intracardiac anatomy and VSD position cannot be well seen by TTE. A larger prospective analysis is warranted to help validate this approach.
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Affiliation(s)
- Philip B Dydynski
- Department of Pediatric Radiology, Kosair Children's Hospital, Norton Healthcare, Louisville, KY, USA
| | - Carmen Kiper
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | - Deborah Kozik
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Bradley B Keller
- Department of Pediatrics, University of Louisville, Louisville, KY, USA Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA
| | - Erle Austin
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Brian Holland
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
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Loughborough WW, Yeong M, Hamilton M, Manghat N. Computed tomography in congenital heart disease: how generic principles can be applied to create bespoke protocols in the Fontan circuit. Quant Imaging Med Surg 2017; 7:79-87. [PMID: 28275561 DOI: 10.21037/qims.2017.02.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac computed tomography (CCT) has become an invaluable cross-sectional imaging modality in congenital heart disease (CHD) patients. However, altered anatomical connections and cardiovascular physiology makes CHD arguably the most challenging area in CCT imaging, which remains a complimentary modality to cardiac magnetic resonance and echocardiography. A bespoke CT protocol is often required to achieve a diagnostic examination; this can be achieved through careful consideration of the basic principles of image acquisition and contrast administration. This article reviews these principles and demonstrates how they can be applied to CCT in CHD using the Fontan circulation as an example.
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Affiliation(s)
- Will W Loughborough
- Department of Clinical Radiology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Michael Yeong
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Mark Hamilton
- Department of Clinical Radiology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Nathan Manghat
- Department of Clinical Radiology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Cohen MS, Eidem BW, Cetta F, Fogel MA, Frommelt PC, Ganame J, Han BK, Kimball TR, Johnson RK, Mertens L, Paridon SM, Powell AJ, Lopez L. Multimodality Imaging Guidelines of Patients with Transposition of the Great Arteries: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2016; 29:571-621. [DOI: 10.1016/j.echo.2016.04.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Tetralogy of Fallot: Preoperative assessment with MR and CT imaging. Diagn Interv Imaging 2016; 97:531-41. [DOI: 10.1016/j.diii.2016.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/06/2016] [Indexed: 11/24/2022]
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Stieger-Vanegas SM, Scollan KF, Meadows L, Sisson D, Schlipf J, Riebold T, Löhr CV. Cardiac-gated computed tomography angiography in three alpacas with complex congenital heart disease. J Vet Cardiol 2016; 18:88-98. [PMID: 26803197 DOI: 10.1016/j.jvc.2015.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 09/03/2015] [Accepted: 09/21/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND The prevalence of congenital heart disease is higher in camelids than in other domestic species and complex defects, often involving the great vessels, are more frequently encountered in llamas and alpacas than in other species. Some of these complex defects can be difficult to accurately characterize via echocardiography, the most commonly used diagnostic imaging technique to evaluate the heart in veterinary patients. Contrast-enhanced, electrocardiogram (ECG)-gated computed tomography (CT) has proven utility for the evaluation of human patients with certain congenital heart defects, including those with conotruncal septation defects and other abnormalities involving the formation of the great vessels. METHODS Three alpaca crias, 4 days, 5 weeks and 14 months of age were clinically evaluated and subjected to a complete color-flow Doppler echocardiogram and a contrast-enhanced ECG-gated CT. RESULTS These alpacas exhibited a variety of clinical findings including lethargy, failure to thrive, exercise intolerance, heart murmur, and/or respiratory difficulty. All three crias were subsequently diagnosed with complex cardiac defects including pulmonary atresia with a ventricular septal defect (VSD), a truncus arteriosus with a large VSD, and a double outlet right ventricle with a large VSD and aortic hypoplasia. In each case, the diagnosis was confirmed by postmortem examination. CONCLUSION Color flow echocardiographic evaluation identified all of the intra-cardiac lesions and associated flow anomalies but contrast-enhanced ECG-gated CT permitted more accurate assessment of the morphology of the extracardiac structures and permitted a more precise determination of the exact nature and anatomy of the great vessels.
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Affiliation(s)
- S M Stieger-Vanegas
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Magruder Hall, Corvallis, OR 97331, USA.
| | - K F Scollan
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Magruder Hall, Corvallis, OR 97331, USA
| | - L Meadows
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Magruder Hall, Corvallis, OR 97331, USA
| | - D Sisson
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Magruder Hall, Corvallis, OR 97331, USA
| | - J Schlipf
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Magruder Hall, Corvallis, OR 97331, USA
| | - T Riebold
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Magruder Hall, Corvallis, OR 97331, USA
| | - C V Löhr
- Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Magruder Hall, Corvallis, OR 97331, USA
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Chakravarthy M, Sunilkumar G, Pargaonkar S, Hosur R, Harivelam C, Kavaraganahalli D, Srinivasan P. Induced apnea enhances image quality and visualization of cardiopulmonary anatomic during contrastenhanced cardiac computerized tomographic angiography in children. Ann Card Anaesth 2016; 18:179-84. [PMID: 25849686 PMCID: PMC4881624 DOI: 10.4103/0971-9784.154471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: The purpose of our study was to determine the effect of induced apnea on quality of cardiopulmonary structures during computerized tomographic (CT) angiography images in children with congenital heart diseases. Methods: Pediatric patients with congenital heart defects undergoing cardiac CT angiography at our facility in the past 3 years participated in this study. The earlier patients underwent cardiac CT angiography without induced apnea and while, later, apnea was induced in patients, which was followed by electrocardiogram gated cardiac CT angiography. General anesthesia was induced using sleep dose of intravenous propofol. After the initial check CT, on request by the radiologist, apnea was induced by the anesthesiologist by administering 1 mg/kg of intravenous suxamethonium. Soon after apnea ensued, the contrast was injected, and CT angiogram carried out. CT images in the “apnea group” were compared with those in “nonapnea group.” After the completion of the procedure, the patients were mask ventilated with 100% oxygen till the spontaneous ventilation was restored. Results: We studied 46 patients, of whom 36 with apnea and yet another 10 without. The quality of the image, visualization of structures such as cardiac wall, outflow tracts, lung field, aortopulmonary shunts, and coronary arteries were analyzed and subjected to statistical analysis (Mann–Whitney U, Fischer's exact test and Pearson's Chi-square test). In the induced apnea group, overall image quality was considered excellent in 89% (n = 33) of the studies, while in the “no apnea group,” only 30% of studies were excellent. Absent or minimal motion artifacts were seen in a majority of the studies in apnea group (94%). In the nonapnea group, the respiratory and body motion artifacts were severe in 50%, moderate in 30%, and minimal in 20%, but they were significantly lesser in the apnea group. All the studied parameters were statistically significant in the apnea group in contrast to nonapnea group (P < 0.000). Conclusion: The image quality of cardiac CT angiography greatly improves, and motion artifact significantly decreases with the use of induced apnea in pediatrics patients being evaluated for congenital heart disease. This technique poses no additional morbidity of significance.
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Affiliation(s)
- Murali Chakravarthy
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
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3D MDCT angiography for the preoperative assessment of truncus arteriosus. Clin Imaging 2015; 39:938-44. [DOI: 10.1016/j.clinimag.2015.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 11/22/2022]
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Han BK, Rigsby CK, Leipsic J, Bardo D, Abbara S, Ghoshhajra B, Lesser JR, Raman SV, Crean AM, Nicol ED, Siegel MJ, Hlavacek A. Computed Tomography Imaging in Patients with Congenital Heart Disease, Part 2: Technical Recommendations. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT). J Cardiovasc Comput Tomogr 2015; 9:493-513. [DOI: 10.1016/j.jcct.2015.07.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/17/2015] [Indexed: 02/06/2023]
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Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT). J Cardiovasc Comput Tomogr 2015; 9:475-92. [DOI: 10.1016/j.jcct.2015.07.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/17/2015] [Indexed: 12/16/2022]
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Assessment of Extracardiac and Intracardiac Anatomy by MD-CT. CONGENIT HEART DIS 2015. [DOI: 10.1007/978-4-431-54355-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abchee A, Saade C, Al-Mohiy H, El-Merhi F. MDCT Venography Evaluation of a Rare Collateral Vein Draining from the Left Subclavian Vein to the Great Cardiac Vein. J Clin Imaging Sci 2014; 4:58. [PMID: 25379351 PMCID: PMC4220423 DOI: 10.4103/2156-7514.143425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/12/2014] [Indexed: 11/25/2022] Open
Abstract
Congenital vascular anomalies of the venous drainage in the chest affect both cardiac and non-cardiac structures. Collateral venous drainage from the left subclavian vein to the great cardiac vein is a rare venous drainage pattern. These anomalies present a diagnostic challenge. Multi-detector computed tomography (MDCT) is useful in the diagnosis and treatment planning of these clinically complex disorders. We present a case report of an 18-year-old Caucasian male who came to our institute for evaluation of venous drainage patterns to the heart. We describe the contrast technique of bilateral dual injection MDCT venography and the imaging features of the venous drainage patterns to the heart.
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Affiliation(s)
- Antoine Abchee
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Charbel Saade
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussain Al-Mohiy
- Department of Radiological Science, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Fadi El-Merhi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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Glockler M, Halbfass J, Koch A, Dittrich S, Achenbach S, Ruffer A, Ihlenburg S, Cesnjevar R, May M, Uder M, Rompel O. Preoperative assessment of the aortic arch in children younger than 1 year with congenital heart disease: utility of low-dose high-pitch dual-source computed tomography. A single-centre, retrospective analysis of 62 cases. Eur J Cardiothorac Surg 2013; 45:1060-5. [DOI: 10.1093/ejcts/ezt537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Han BK, Lesser AM, Vezmar M, Rosenthal K, Rutten-Ramos S, Lindberg J, Caye D, Lesser JR. Cardiovascular imaging trends in congenital heart disease: a single center experience. J Cardiovasc Comput Tomogr 2013; 7:361-6. [PMID: 24331931 DOI: 10.1016/j.jcct.2013.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/04/2013] [Accepted: 11/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) and CT are available in the recent era at many pediatric cardiac centers. OBJECTIVE The aim was to provide a contemporary description of diagnostic imaging trends for definition of congenital heart disease (CHD). METHODS Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT use in patients with congenital heart disease at a single institution was retrospectively recorded (2005-2012). Surgical procedures were recorded. Total and modality-specific rates were estimated by Poisson regression and compared. The median age, studies in patients aged >17 years, and referral diagnosis were tabulated for the last year of review. RESULTS An average of 11,940 cardiovascular diagnostic tests was performed annually. The number of total studies, echocardiograms, catheterizations, and surgical procedures, did not change significantly across time. Echocardiography comprised 95% to 97% of all studies performed during each year of review. The use of cardiac MRI (2%) and cardiac CT (1%) increased linearly (P < .001), and the use of diagnostic catheterization decreased (0.7%; P = .0005). The median age was 3 years for echocardiography, 15 years for MRI, 11 years for CT, and 3 years for catheterization. The percentage of patients aged >17 years was 9% for echocardiography, 33% for cardiac MRI, 29% for cardiac CT, and 8% for catheterization. Most patients undergoing CT, MRI, and diagnostic catheterization had moderate or complex CHD. CONCLUSION Cardiac CT is used increasingly in the recent era for evaluation of CHD. The increased use of both cardiac CT and cardiac MRI are temporally associated with a decrease in diagnostic cardiac catheterization.
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Affiliation(s)
- B Kelly Han
- The Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota, 2530 Chicago Ave South, Suite 500, Minneapolis, MN 55404, USA; The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA.
| | - Andrew M Lesser
- The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA
| | - Marko Vezmar
- The Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota, 2530 Chicago Ave South, Suite 500, Minneapolis, MN 55404, USA
| | - Kristi Rosenthal
- The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA
| | | | - Jana Lindberg
- The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA
| | - David Caye
- The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA
| | - John R Lesser
- The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA
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Abstract
OBJECTIVE The purpose of this article is to review the imaging findings of common and uncommon causes of renin-mediated hypertension in children using a multimodality radiologic approach. CONCLUSION Pediatric hypertension, although uncommon, is often due to aortic or renal artery narrowing. Imaging plays an important role in the diagnosis and characterization of pediatric renin-mediated causes of hypertension.
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Trinavarat P. Computed tomographic angiography (CTA) of major thoracic vessels in children—A pictorial assay on common findings also discussing CTA technique. Eur J Radiol 2013; 82:1083-90. [DOI: 10.1016/j.ejrad.2011.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Han BK, Lesser JR. Cardiac CT in the Diagnosis and Postoperative Assessment of Congenital Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Watts JR, Sonavane SK, Singh SP, Nath PH. Pictorial Review of Multidetector CT Imaging of the Preoperative Evaluation of Congenital Heart Disease. Curr Probl Diagn Radiol 2013; 42:40-56. [DOI: 10.1067/j.cpradiol.2012.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Volumetric Computed Tomography Angiography in the Evaluation of Mediastinal Fluid Collections following Congenital Cardiac Surgery. Case Rep Pediatr 2013; 2013:426923. [PMID: 23424699 PMCID: PMC3569889 DOI: 10.1155/2013/426923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/27/2012] [Indexed: 11/18/2022] Open
Abstract
We present 3 patients with 4 causes of mediastinal fluid collection after congenital cardiac surgery in this extended case report. Volumetric computed tomography played an essential role in diagnosing causes and extent, relevant to subsequent management. Recent advances in volumetric computed tomography allow fast and accurate imaging of cardiovascular and extravascular structures in children with acceptable radiation dose, providing a powerful imaging tool for the evaluation of complications after congenital cardiac surgery.
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Mohan S, Poff S, Torok KS. Coronary artery involvement in pediatric Takayasu's arteritis: Case report and literature review. Pediatr Rheumatol Online J 2013; 11:4. [PMID: 23398983 PMCID: PMC3575318 DOI: 10.1186/1546-0096-11-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/05/2013] [Indexed: 11/29/2022] Open
Abstract
Takayasu's arteritis (TA) is a form of chronic vasculitis that typically occurs in young adult Asian females, but it can also present in younger patients not fitting this classic profile. In these cases, the sequelae are generally similar to those found in adults. The disease predominantly affects the aorta and its primary branches. However, the coronary arteries are also affected in up to 20% of cases, which may precipitate myocardial infarction. Imaging of the coronary arteries therefore becomes critically important in the evaluation of a patient with possible Takayasu's arteritis. We present a case of a pediatric patient with TA who had no symptoms of angina but who was found to have significant coronary artery involvement on diagnostic imaging. This necessitated tailoring of traditional management.
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Affiliation(s)
- Shaun Mohan
- Division of Pediatric Rheumatology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 15224, Pittsburgh, PA, USA.
| | - Sarah Poff
- Division of Pediatric Rheumatology, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 15224, Pittsburgh, PA, USA
| | - Kathryn S Torok
- Division of Pediatric Rheumatology, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 15224, Pittsburgh, PA, USA
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Uncommon congenital extracardiac vascular anomalies detected on MSCT (Multi-Slice Computed Tomography) aortic angiography with 64-multislice technology. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2011.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Pauwels EKJ, Bourguignon MH. Radiation dose features and solid cancer induction in pediatric computed tomography. Med Princ Pract 2012; 21:508-15. [PMID: 22472997 DOI: 10.1159/000337404] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 01/24/2012] [Indexed: 12/17/2022] Open
Abstract
Over the past two decades technical advances and improvements have made computed tomography (CT) a valuable and essential tool in the array of diagnostic imaging modalities. CT uses ionizing radiation (X-rays) which may damage DNA and increase the risk of carcinogenesis. This is especially pertinent in pediatric CT as children are more radiosensitive and have a longer life expectancy than adults. The purpose of this paper is to review and elucidate the potential harmful effects of ionizing radiation in terms of solid cancer induction from pediatric CT scanning. In the light of scientific and technical developments, we will also discuss the possible strategies and ongoing efforts to reduce CT radiation exposure in pediatric patients. In this context, we will not ignore the fact that a well-justified CT scan may exceed its risk and have a favorable impact.
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Affiliation(s)
- Ernest K J Pauwels
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. ernestpauwels @ gmail.com
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