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Zhou C, Guo Y, Zeng Y, Ke H. Abnormal origin of the left pulmonary artery. Eur Heart J Case Rep 2024; 8:ytae280. [PMID: 38947145 PMCID: PMC11211917 DOI: 10.1093/ehjcr/ytae280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 07/02/2024]
Affiliation(s)
- Chunyi Zhou
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi 530021, China
| | - Yurong Guo
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi 530021, China
| | - Yancong Zeng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi 530021, China
| | - Honghong Ke
- Department of Geriatric Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi 530021, China
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2
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Patel H, Malhotra P, Patel K, Patel M, Gajjar T, Mishra A, Sheth M. Aortic Origin of a Branch Pulmonary Artery: Early and Mid-Term Single Center Outcomes. World J Pediatr Congenit Heart Surg 2024; 15:365-370. [PMID: 38263672 DOI: 10.1177/21501351231221467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Anomalous origin of pulmonary artery (AOPA) is a rare congenital cardiac anomaly. It requires early surgical intervention (<6 months) to prevent irreversible pulmonary vaso-occlusive disease. This study was conducted to determine the surgical outcomes of this rare and intriguing anomaly. METHODS From January 2015 to 2022, we have studied, 20 patients who underwent surgical correction for this anomaly with a mean age of 6.25 ± 3.7 months. There were 12 patients of <6 months of age. Their preoperative, intraoperative, and postoperative data were collected. They were followed up at every three months for the first year, every six months for two years, and then annually. RESULTS Among three early mortalities, two were operated before six months of age and one was older than six months (ten months). Those patients presented after six months had longer ventilation time (P = .001). There was no difference in their pulmonary artery pressure (P = .06), right ventricle systolic pressure (RVSP) (P = .85), postoperative saturation (P = .51), inotropic score (P = .06), hospital and intensive care unit stay (P > .05), or mortality (P = .79). There was no late mortality at mean follow-up of 51.31 ± 20.27 months with Kaplan-Meier survival of 85% at 1, 5, and ten years. All patients were asymptomatic, with normal biventricular function and RVSP. One patient required balloon dilatation of the anastomotic site, with Kaplan-Meier event-free survival of 100% at one year, 92% at five and ten years. CONCLUSION Surgical correction of AOPA in patients beyond six months is still feasible with a higher early morbidity and comparable mortality with good clinical and echocardiographical outcomes at mid-term follow-up.
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Affiliation(s)
- Herin Patel
- Department of Cardiovascular & Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Pulkit Malhotra
- Department of Cardiovascular & Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Kartik Patel
- Department of Cardiovascular & Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Mrinal Patel
- Department of Cardiovascular & Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Trushar Gajjar
- Department of Pediatric Cardiovascular & Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Amit Mishra
- Department of Pediatric Cardiovascular & Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Megha Sheth
- Department of Radiology, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
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3
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Karila-Cohen J, Gaudin R, Malekzadeh-Milani S, Derridj N, Panaioli E, Raisky O, Bonnet D. Congenital disconnection of the pulmonary arteries. Eur J Cardiothorac Surg 2023; 64:ezad245. [PMID: 37348856 DOI: 10.1093/ejcts/ezad245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES Disconnected pulmonary artery (PA) is a rare anomaly that can be isolated or associated with complex intracardiac malformations. Early reimplantation of the disconnected PA is recommended to allow growth and satisfactory pulmonary perfusion while preventing collateral artery development. The aim of this study was to describe the characteristics of patients with disconnected PA and, for those who had surgical reimplantation, to determine the incidence, delay and predictive factors of reintervention for reconnected PA stenosis. METHODS We include patients with the diagnosis of congenitally disconnected PA and surgical repair at our institution. RESULTS Retrospective observational study of 55 patients with a disconnected PA. Fifty-one underwent surgical correction and were followed up at our institution between 2000 and 2022. Disconnected PAs were observed in isolation in 31% of the cases. The most frequent form was left PA originating from the arterial duct (58%). The reimplantation was done at the median age of 12 days. Anastomotic stenosis was observed during follow-up in 71% of the patients with 75% of them requiring reintervention (55% of the population). The median delay to reintervention was 3.2 years after reimplantation, and >25% of reinterventions on the reimplanted PA occurred within the first postoperative year. We found more reintervention if associated cardiac defect, without significant statistic difference. Weight at re-confluence, presence of ductal tissue at the origin of the PA and prior shunt placement on the disconnected PA were not found to be risk factors for reintervention. DISCUSSION After surgical reimplantation of PA, >50% of patients required reintervention for PA stenosis. Technical improvements should be sought to reduce the incidence of this complication.
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Affiliation(s)
- Julie Karila-Cohen
- Medical and surgical unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects-M3C, University Hospital Necker-Enfants Malades, Paris, France
| | - Régis Gaudin
- Medical and surgical unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects-M3C, University Hospital Necker-Enfants Malades, Paris, France
| | - Sophie Malekzadeh-Milani
- Medical and surgical unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects-M3C, University Hospital Necker-Enfants Malades, Paris, France
| | - Neil Derridj
- Medical and surgical unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects-M3C, University Hospital Necker-Enfants Malades, Paris, France
- University of Paris Cité, Paris, France
| | - Elena Panaioli
- Medical and surgical unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects-M3C, University Hospital Necker-Enfants Malades, Paris, France
| | - Olivier Raisky
- Medical and surgical unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects-M3C, University Hospital Necker-Enfants Malades, Paris, France
- University of Paris Cité, Paris, France
| | - Damien Bonnet
- Medical and surgical unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects-M3C, University Hospital Necker-Enfants Malades, Paris, France
- University of Paris Cité, Paris, France
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4
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Abstract
Online supplemental material is available for this article.
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Affiliation(s)
- Lin Zhou
- From the Department of Radiology, Third Affiliated Hospital of Chengdu Medical College & Pidu District People's Hospital, Chengdu, China (L.Z.); and Department of Radiology, Shenzhen Children's Hospital, Yitian Rd 4017, Shenzhen 518034, China (X.L.)
| | - Xinyi Liu
- From the Department of Radiology, Third Affiliated Hospital of Chengdu Medical College & Pidu District People's Hospital, Chengdu, China (L.Z.); and Department of Radiology, Shenzhen Children's Hospital, Yitian Rd 4017, Shenzhen 518034, China (X.L.)
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5
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Nagulakonda S, Ojha V, Malhi AS, Balaji A, Singh R, Jagia P. A rare case of tetralogy of Fallot-pulmonary atresia with absent right pulmonary artery and anomalous origin of left pulmonary artery from ascending aorta. J Card Surg 2022; 37:1718-1719. [PMID: 35338714 DOI: 10.1111/jocs.16455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
We report a case of a 5-year-old child with tetralogy of Fallot-pulmonary atresia with anomalous origin of left pulmonary artery from ascending aorta and right lung supplied by collateral arteries. This case highlights the role of preoperative CT angiography in differentiating this entity from a common arterial trunk with discontinuous pulmonary arteries.
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Affiliation(s)
- Sravan Nagulakonda
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder Singh Malhi
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Balaji
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Resham Singh
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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6
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Verma M, Pandey NN, Ramakrishnan S, Jagia P. Anomalous origin of one pulmonary artery from aorta: Evaluation on computed tomography angiography. J Card Surg 2022; 37:483-491. [PMID: 35018673 DOI: 10.1111/jocs.16229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
AIM The present study sought to evaluate the morphology and associated cardiovascular anomalies in patients with anomalous origin of one pulmonary artery from aorta (AOPA) on CT angiography. MATERIALS AND METHODS A retrospective search of the departmental database from January 2014 to September 2021 was conducted to identify patients diagnosed with AOPA on CT angiography. The subtype of AOPA, site of origin, and associated cardiovascular abnormalities were assessed. RESULTS AOPA was identified in 27 patients (19 males, mean age: 8.8 years). Anomalous origin of the right pulmonary artery from aorta (AORPA) was observed in 17/27 (63%) patients, while anomalous origin of the left pulmonary artery (AOLPA) was seen in 10/27 (37%) patients. The proximal and distal subtypes were observed in 24/27 (88.9%) and 3/27 (11.1%) patients respectively. AOPA was associated with other cardiac anomalies in 92.6% (25/27) patients. Patent arterial duct (11/17; 64.7%) was the most frequently anomaly associated with AORPA, while tetralogy of Fallot (10/10; 100%) was the most commonly anomaly associated with AOLPA. The anomalous pulmonary artery was contralateral to the aortic arch in 23/27 (85.2%) patients. Right-sided aortic arch was observed in only 2/17 (11.8%) patients with AORPA and 8/10 (80%) patients with AOLPA. In 2/10 (20%) patients, AORPA was associated with aortopulmonary window and aortic arch anomaly. CONCLUSION AOPA is rare and frequently associated with other cardiovascular anomalies like patent arterial duct, tetralogy of Fallot, and right-sided aortic arch. CT angiography helps in providing exact anatomical delineation and identifying associated anomalies, thus aiding preoperative planning of surgical management.
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Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | | | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Alhawri K, Alakhfash A, Alqwaee A, HassabElnabi M, Ahmed F, Alhawri M, Nasser B, Alhoobani M, Mazzesi G, Alsaeedi A, Almesned A. Anomalous right pulmonary artery from aorta, surgical approach case report and literature review. J Card Surg 2021; 36:2890-2900. [PMID: 34047395 PMCID: PMC8361962 DOI: 10.1111/jocs.15618] [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] [Received: 04/17/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anomalous origin of one pulmonary artery from the aorta is a rare congenital anomaly affecting the right pulmonary artery more than the left. These patients are at risk for the early development of significant pulmonary hypertension. Early surgical treatment has been proven safe with excellent results. The surgical approach and technique is challenging and should be decided ahead before the patient to surgery. Different techniques were described including direct reimplantation, conduit interposition, aortic ring flap. AIM We present a neonate with anomalous origin of the right pulmonary artery from the aorta and discuss the surgical technique and complications in the literature.
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Affiliation(s)
- Khaled Alhawri
- Prince Sultan Cardiac Center-Qassim, Buraydah, Saudi Arabia.,Department of General and Specialized Surgery 'Paride Stefanini' Dottorato di Ricerca, La Sapienza, University of Rome, Rome, Italy
| | - Ali Alakhfash
- Prince Sultan Cardiac Center-Qassim, Buraydah, Saudi Arabia.,Department of General and Specialized Surgery 'Paride Stefanini' Dottorato di Ricerca, La Sapienza, University of Rome, Rome, Italy
| | | | | | - Fazel Ahmed
- Prince Sultan Cardiac Center-Qassim, Buraydah, Saudi Arabia
| | - Mohammed Alhawri
- International University of Malaya Wales, Kuala Lumpur, Malaysia
| | - Bana Nasser
- Prince Sultan Cardiac Center-Qassim, Buraydah, Saudi Arabia
| | | | - Giusseppe Mazzesi
- Department of General and Specialized Surgery 'Paride Stefanini' Dottorato di Ricerca, La Sapienza, University of Rome, Rome, Italy
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8
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Said SM, Marey G, Brown NM, Griselli M, Rodgers N, Zupfer EH, Aggarwal V, Hiremath GM. Anomalous Aortic Origin of the Right Pulmonary Artery From the Ascending Aorta With Spontaneous Dissection and Thrombosis. World J Pediatr Congenit Heart Surg 2021; 11:531-533. [PMID: 32645784 DOI: 10.1177/2150135120913804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anomalous aortic origin of the pulmonary artery is rare. It can affect either of the main branches and can be an important cause of neonatal respiratory distress. Early diagnosis and surgical repair is associated with improved survival and long-term outcomes.
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Affiliation(s)
- Sameh M Said
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Gamal Marey
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Nicholas M Brown
- Division of Pediatric Critical Care, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Massimo Griselli
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Nathan Rodgers
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Elena H Zupfer
- Division of Pediatric Anesthesia, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Gurumurthy M Hiremath
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
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9
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Loomba RS, Aiello S, Tretter JT, Gaffar M, Reppucci J, Brock MA, Spicer D, Anderson RH. Left Pulmonary Artery from the Ascending Aorta: A Case Report and Review of Published Cases. J Cardiovasc Dev Dis 2020; 8:1. [PMID: 33375662 PMCID: PMC7824649 DOI: 10.3390/jcdd8010001] [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: 11/20/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022] Open
Abstract
The left pulmonary artery arising from the ascending aorta is an infrequent finding. It may be found isolated or with intracardiac anomalies. We present a new case of the left pulmonary artery arising from the ascending aorta and pool these findings with those of previously reported cases. Associated cardiac, extracardiac, and syndromic findings are discussed along with the implications of these in the evaluation and management of this condition.
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Affiliation(s)
- Rohit S. Loomba
- Department of Pediatric Cardiology, Advocate Children’s Hospital, Oak Lawn, IL 60453, USA
- Department of Pediatrics, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60543, USA;
| | - Salvatore Aiello
- Department of Pediatrics, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60543, USA;
| | - Justin T. Tretter
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45299, USA;
| | - Maira Gaffar
- Department of Pediatric Cardiology, University of Florida, Gainseville, FL 32611, USA; (M.G.); (J.R.); (M.A.B.); (D.S.)
| | - Jennifer Reppucci
- Department of Pediatric Cardiology, University of Florida, Gainseville, FL 32611, USA; (M.G.); (J.R.); (M.A.B.); (D.S.)
| | - Michael A. Brock
- Department of Pediatric Cardiology, University of Florida, Gainseville, FL 32611, USA; (M.G.); (J.R.); (M.A.B.); (D.S.)
| | - Diane Spicer
- Department of Pediatric Cardiology, University of Florida, Gainseville, FL 32611, USA; (M.G.); (J.R.); (M.A.B.); (D.S.)
| | - Robert H. Anderson
- Department of pediatrics, Newcastle University, Newcastle Upon Tyne NE17RU, UK;
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10
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Warin Fresse K, Isorni MA, Dacher JN, Pontana F, Gorincour G, Boddaert N, Jacquier A, Raimondi F. Cardiac computed tomography angiography in the paediatric population: Expert consensus from the Filiale de cardiologie pédiatrique et congénitale (FCPC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV). Arch Cardiovasc Dis 2020; 113:579-586. [PMID: 32522436 DOI: 10.1016/j.acvd.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/30/2022]
Abstract
This paper aims to provide a paediatric cardiac computed tomography angiography expert panel consensus based on the opinions of experts from the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) and the Filiale de cardiologie pédiatrique congénitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, computed tomography angiography radiation dose reduction techniques and postprocessing techniques. We think that to realize its full potential and to avoid pitfalls, cardiac computed tomography angiography in children with congenital heart disease requires training and experience. Moreover, paediatric cardiac computed tomography angiography protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible, to prevent unnecessary radiation exposure. We also provide a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.
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Affiliation(s)
- Karine Warin Fresse
- Imagerie cardiovasculaire fédération des cardiopathies congénitales, CHU de Nantes HGRL, 44093 Nantes, France
| | - Marc Antoine Isorni
- Unité de radiologie diagnostique et thérapeutique, hôpital Marie-Lannelongue, 92350 Le Plessis Robinson, France
| | - Jean Nicolas Dacher
- Cardiac MR/CT Unit, University Hospital, 76031 Rouen, France; Inserm U1096, UFR Médecine-Pharmacie, 76183 Rouen, France
| | - François Pontana
- Inserm UMR 1011, Department of Cardiovascular Radiology, EGID (European Genomic Institute for Diabetes), université de Lille, Institut Cœur-Poumon, Institut Pasteur de Lille, CHU de Lille, FR3508, 59000 Lille, France
| | - Guillaume Gorincour
- Image(2), institut méditerranéen d'imagerie médicale appliquée à la gynecologie, grossesse et enfance, 13008 Marseille, France
| | - Nathalie Boddaert
- Paediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, 75743 Paris, France
| | - Alexis Jacquier
- Department of Radiology, University of Marseille Méditerranée, CHU La Timone, Marseille, France
| | - Francesca Raimondi
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes (M3C), hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
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11
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Anomalous origin of right pulmonary artery: diagnosis, treatment, and follow-up in an adult patient. Cardiol Young 2020; 30:1199-1201. [PMID: 32624062 DOI: 10.1017/s1047951120001729] [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: 11/05/2022]
Abstract
Anomalous origin of a branch pulmonary artery from the aorta is a rare malformation, accounting for 0.12% of all congenital heart defects. We present the case of a 43-year-old man with an anomalous origin of the right pulmonary artery (AORPA) from the ascending aorta. Reimplantation of the right pulmonary artery was carried out successfully, with favourable evolution in the medium-term follow-up. It is the first described case that receives corrective treatment in adulthood with a favourable evolution.
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12
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Newman B, Alkhori N. Congenital central pulmonary artery anomalies: Part 2. Pediatr Radiol 2020; 50:1030-1040. [PMID: 32500159 DOI: 10.1007/s00247-020-04703-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/21/2020] [Accepted: 05/04/2020] [Indexed: 12/13/2022]
Abstract
There is a broad spectrum of congenital anomalies of the central pulmonary arteries including abnormalities of development, origin, course and caliber. These anomalies incorporate simple lesions such as isolated pulmonary valve stenosis to very complex anomalies with many associated abnormalities. Part 1 and Part 2 of this review describe the range of anatomical variations that are encountered as well as important aspects of anatomy, physiology and surgical correction. The authors summarize and illustrate both well-recognized and more complex anomalies to provide a broad and comprehensive understanding of these lesions and their appearances on CT and MR imaging. In Part 2 the authors review abnormalities in development, origin and course of the central branch pulmonary arteries as well as abnormal pulmonary artery caliber.
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Affiliation(s)
- Beverley Newman
- Department of Radiology, Stanford Children's Hospital, 725 Welch Road, Stanford, CA, 94304, USA.
| | - Noor Alkhori
- Department of Clinical Radiology, Sidra Medicine, Weill Cornell Medicine, Doha, Qatar
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13
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Warin-Fresse K, Isornii MA, Dacher JN, Pontana F, Gorincour G, Boddaert N, Jacquier A, Raimondi F. Pediatric cardiac computed tomography angiography: Expert consensus from the Filiale de Cardiologie Pédiatrique et Congénitale (FCPC) and the Société Française d'Imagerie Cardiaque et Vasculaire diagnostique et interventionnelle (SFICV). Diagn Interv Imaging 2020; 101:335-345. [PMID: 32029386 DOI: 10.1016/j.diii.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023]
Abstract
This article was designed to provide a pediatric cardiac computed tomography angiography (CCTA) expert panel consensus based on opinions of experts of the Société Française d'Imagerie Cardiaque et Vasculaire diagnostique et interventionnelle (SFICV) and of the Filiale de Cardiologie Pédiatrique Congénitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, CTA radiation dose reduction techniques, and post-processing techniques. The consensus was based on data from available literature (original papers, reviews and guidelines) and on opinions of a group of specialists with extensive experience in the use of CT imaging in congenital heart disease. In order to reach high potential and avoid pitfalls, CCTA in children with congenital heart disease requires training and experience. Moreover, pediatric cardiac CCTA protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible to prevent unnecessary radiation exposure. We also provided a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.
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Affiliation(s)
- K Warin-Fresse
- Department of Cardiovascular Imaging, CHU Nantes HGRL, 44093 Nantes, France
| | - M-A Isornii
- Department of Radiology, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
| | - J-N Dacher
- Department of Radiology, Rouen University Hospital, 76031 Rouen, France; Inserm U1096, UFR Médecine-Pharmacie, University of Rouen, 76000 Rouen, France
| | - F Pontana
- Department of Cardiovascular Radiology, Institut Cœur-Poumon, CHU Lille, INSERM UMR 1011, Institut Pasteur de Lille, EGID, FR3508, Univ Lille, 59000 Lille, France
| | - G Gorincour
- Image2, Mediterranean Institute of Medical Imaging, 13008 Marseille, France
| | - N Boddaert
- Pediatric Radiology Unit, Hôpital Universitaire Necker Enfants-Malades, 75015 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - A Jacquier
- Department of Radiology, University of Marseille Méditerranée, CHU la Timone, 13000 Marseille, France
| | - F Raimondi
- Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, 75015 Paris, France.
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14
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Anomalous origin of a pulmonary artery in a teenager with tetralogy of Fallot with associated double aortic arch and coronary arteriovenous fistula. Cardiol Young 2019; 29:727-729. [PMID: 31133077 DOI: 10.1017/s1047951119000933] [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: 11/06/2022]
Abstract
We report the case of a 14-year-old female who had tetralogy of Fallot along with anomalous origin of the left pulmonary artery from the ascending aorta with co-dominant double aortic arch forming a complete vascular ring compressing the oesophagus along with a left main coronary artery to right ventricular outflow tract fistula. She underwent surgical correction without conduit placement.
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Agati S, Sousa CG, Calvaruso FD, Zanai R, Campanella I, Poli D, Di Pino A, Borro L, Iorio FS, Raponi M, Anderson RH, Reali S, De Zorzi A, Secinaro A. Anomalous aortic origin of the pulmonary arteries: Case series and literature review. Ann Pediatr Cardiol 2019; 12:248-253. [PMID: 31516282 PMCID: PMC6716331 DOI: 10.4103/apc.apc_89_18] [Citation(s) in RCA: 7] [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] [Indexed: 12/12/2022] Open
Abstract
Anomalous origin of the pulmonary arteries from the ascending aorta is a rare, but severe clinical entity necessitating a scrupulous evaluation. Either the right or the left pulmonary arteries can arise directly from the ascending aorta while the other pulmonary artery retains its origin from the right ventricular outflow tract. Such a finding can be isolated or can coexist with several congenital heart lesions. Direct intrapericardial aortic origin, however, must be distinguished with origin through a persistently patent arterial duct. In the current era, clinical manifestations usually become evident in the newborn rather than during infancy, as used to be the case. They include respiratory distress or congestive heart failure due to increased pulmonary flow and poor feeding. The rate of survival has now increased due to early diagnosis and prompt surgical repair, should now be expected to be at least 95%. We have treated four neonates with this lesion over the past 7 years, all of whom survived surgical repair. Right ventricular systolic pressure was significantly decreased at follow-up. Our choice of treatment was to translocate the anomalous pulmonary artery in end-to-side fashion to the pulmonary trunk. Our aim in this report is to update an Italian experience in the diagnosis and treatment of anomalous direct origin of one pulmonary artery from the aorta, adding considerations on the lessons learned from our most recent review of the salient literature.
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Affiliation(s)
- Salvatore Agati
- Mediterranean Congenital Heart Center - Bambino Gesù - San Vincenzo Hospital, Taormina, Italy
| | | | - Felice Davide Calvaruso
- Mediterranean Congenital Heart Center - Bambino Gesù - San Vincenzo Hospital, Taormina, Italy
| | - Rosanna Zanai
- Mediterranean Congenital Heart Center - Bambino Gesù - San Vincenzo Hospital, Taormina, Italy
| | - Ivana Campanella
- Mediterranean Congenital Heart Center - Bambino Gesù - San Vincenzo Hospital, Taormina, Italy
| | - Daniela Poli
- Mediterranean Congenital Heart Center - Bambino Gesù - San Vincenzo Hospital, Taormina, Italy
| | - Alfredo Di Pino
- Mediterranean Congenital Heart Center - Bambino Gesù - San Vincenzo Hospital, Taormina, Italy
| | - Luca Borro
- Department of Clinical Directors, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Fiore Salvatore Iorio
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | | | - Simone Reali
- Mediterranean Congenital Heart Center - Bambino Gesù - San Vincenzo Hospital, Taormina, Italy
| | - Andrea De Zorzi
- Mediterranean Congenital Heart Center - Bambino Gesù - San Vincenzo Hospital, Taormina, Italy
| | - Aurelio Secinaro
- Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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16
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Li S, Wen H, Liang M, Luo D, Qin Y, Liao Y, Ouyang S, Bi J, Tian X, Norwitz ER, Luo G. Congenital abnormalities of the aortic arch: revisiting the 1964 Stewart classification. Cardiovasc Pathol 2018; 39:38-50. [PMID: 30623879 DOI: 10.1016/j.carpath.2018.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022] Open
Abstract
The traditional classification of congenital aortic arch abnormalities was described by James Stewart and colleagues in 1964. Since that time, advances in diagnostic imaging technology have led to better delineation of the vasculature anatomy and the identification of previously unrecognized and unclassified anomalies. In this manuscript, we review the existing literature and propose a series of modifications to the original Stewart classification of congenital aortic arch abnormalities to incorporate this new knowledge. In brief, we propose the following modifications: (1) In Group I, we further divide subgroup B into left arch atretic and right arch atretic; (2) In Group II, we add three more subgroups, including aberrant right innominate artery, "isolated" right innominate artery (RIA), "isolated" right carotid artery with aberrant right subclavian artery; (3) In Groups I, II, and III, we add a subgroup of absence of both ductus arteriosus; and (4) In Group IV, we add three subgroups, including circumflex retro-esophageal aorta arch, persistent V aortic arch, and anomalous origin of pulmonary artery from ascending aorta.
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Affiliation(s)
- Shengli Li
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, 518028, China.
| | - Huaxuan Wen
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, 518028, China
| | - Meiling Liang
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, 518028, China
| | - Dandan Luo
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, 518028, China
| | - Yue Qin
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, 518028, China
| | - Yimei Liao
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, 518028, China
| | - Shuyuan Ouyang
- Department of Laboratory Medicine, Shenzhen Maternity & Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, 518028, China
| | - Jingru Bi
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, 518028, China
| | - Xiaoxian Tian
- Department of Ultrasound, Maternity & Child Healthcare Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 538001, China
| | - Errol R Norwitz
- Department of Obstetrics & Gynecology, Tufts University School of Medicine, Boston, MA 02111
| | - Guoyang Luo
- Department of Obstetrics & Gynecology, Howard University, College of Medicine, Washington, DC 20060, USA.
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17
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Mei M, Nie J, Yang ZS, Sun HW, Wang H, Kang XM. Comparison of echocardiography and 64-slice spiral computed tomography in the diagnosis of congenital heart disease in children. J Cell Biochem 2018; 120:3969-3977. [PMID: 30321464 DOI: 10.1002/jcb.27682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023]
Abstract
The diagnosis of congenital heart disease in children has been an issue in the medical community. Timely diagnosis and treatment can provide a greater guarantee for children's healthy growth. In recent years, there have been more and more studies on the diagnosis of congenital heart disease in children. This paper compares the advantages and disadvantages of echocardiography and 64-slice spiral computed tomography (CT) in the diagnosis of congenital heart disease in children. In clinical trials, we also tested 64 patients with spiral computed tomography (SCT) and transthoracic echocardiography (TTE) detection of patients and then confirmed the accuracy of the diagnosis by the surgical methods. The two methods of detection, the rate of missed diagnosis, and the rate of misdiagnosis were counted. Through the test results and pathological diagnosis results, the diagnostic accuracy of the two methods were all above 90%, each with its own advantages and disadvantages. The sensitivity of echocardiographic in detecting intracardiac structure abnormalities was relatively high, but when the diagnosis of extracardiac structural abnormalities less than 64-slice spiral CT method, misdiagnosis of TTE was mainly due to extracardiac vascular malformations. Therefore, it is recommended to combine the two methods to improve the diagnosis of congenital heart disease in children.
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Affiliation(s)
- Mei Mei
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Jing Nie
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Zhan Shuang Yang
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Hua Wei Sun
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - He Wang
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Xiao Ming Kang
- The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
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18
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Li A, Peng Z, Zhang C. Comparison of Echocardiography and 64-Multislice Spiral Computed Tomography for the Diagnosis of Pediatric Congenital Heart Disease. Med Sci Monit 2017; 23:2258-2266. [PMID: 28500278 PMCID: PMC5439403 DOI: 10.12659/msm.901546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The goals of this study were: to compare echocardiogram and 64-multislice spiral computed tomography (64-MSCT) in diagnosing pediatric congenital heart disease; to determine the significance of ECHO for diagnosing congenital heart disease; and to identify the appropriate diagnosis for congenital heart disease through combined use of 64-MSCT and ECHO. MATERIAL AND METHODS Thirty patients underwent both ECHO and 64-MSCT diagnoses before their surgeries. Imaging from ECHO and 64-MSCT were analyzed by 4 specialists. The diagnostic accuracy and kappa value of ECHO and 64-MSCT were evaluated based on the operation results. The accuracy of the 2 methods was evaluated using the McNemar χ² test. RESULTS We confirmed 138 malformations in 30 children by surgery. The diagnostic accuracy of ECHO and 64-MSCT was 98.40% and 96.20%, respectively, with a significant difference between the 2 results (χ²=6.404, P=0.011). We compared prognosis accuracy and uniformity on 3 types of congenital heart disease (cardiac malformation, heart-large vascular connecting malformation, and large vascular malformation): 56 cardiac malformations were confirmed by surgery, in which the diagnostic accuracy of ECHO and 64-MSCT was 99.50% and 94.80%, respectively. (χ²=8.578, P=0.034); 31 heart-large vascular connecting malformations were confirmed by surgery, in which the diagnostic accuracy of ECHO and 64-MSCT was 99.00% and 95.42% (χ²=6.779, P=0.009); and 51 vascular malformations were confirmed, in which the diagnostic accuracy of ECHO and 64-MSCT was 96.30% and 98.30% (χ²=1.806, P=0.179). CONCLUSIONS ECHO is more effective than 64-MSCT in preoperative diagnosis of congenital heart disease, especially for children.
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Affiliation(s)
- Aiyin Li
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Chengqi Zhang
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
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Evaluation of left pulmonary artery sling, associated cardiovascular anomalies, and surgical outcomes using cardiovascular computed tomography angiography. Sci Rep 2017; 7:40042. [PMID: 28053308 PMCID: PMC5215389 DOI: 10.1038/srep40042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/30/2016] [Indexed: 11/26/2022] Open
Abstract
We evaluated the prevalence, image appearance, associated cardiovascular anomalies, and surgical outcomes of left pulmonary artery sling (LPAS) using cardiovascular computed tomography angiography (CCTA). A retrospective search of patients from our database between October 2007 and December 2014 identified 52,200 patients with congenital heart diseases (CHD) referred for CCTA, echocardiography, or magnetic resonance imaging. Clinical information, CCTA findings, associated cardiovascular anomalies, and surgical outcomes were analyzed. We showed a hospital-based prevalence of 71 patients with LPAS (0.14%, 71/52,200) among CHD patients. Of these, 47 patients with CCTA examinations were assessed further. Most patients (40/47, 85%) had associated cardiovascular anomalies, of which ventricular septal defects (22/47, 47%), atrial septal defects (20/47, 43%), patent ductus arteriosus (16/47, 34%), persistent left superior vena cava (14/47, 30%), and abnormal branching of the right pulmonary artery (ABRPA) (14/47, 30%) were most commonly identified. In total, 28 patients underwent LPA reanastomosis and/or tracheoplasty in our center, and 5 died. LPAS had a hospital-based prevalence of 0.14% among CHD patients. ABRPA is not uncommon and must be recognized. CCTA is a feasible method for demonstrating LPAS and its associated cardiovascular anomalies for an optimal pre-operative assessment of LPAS.
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20
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Raimondi F, Warin-Fresse K. Computed tomography imaging in children with congenital heart disease: Indications and radiation dose optimization. Arch Cardiovasc Dis 2016; 109:150-7. [PMID: 26782623 DOI: 10.1016/j.acvd.2015.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022]
Abstract
Computed tomography (CT) technology is acquiring a key role in the diagnostic process of complex cardiac congenital anomalies. Recent advances and improvements in spatial and temporal resolution and radiation dose are encouraging the use of CT scanning in children. Paediatric cardiologists should have a good knowledge of the potential of CT techniques and their limitations to plan and properly perform CT examinations without forgetting radiation concerns. In this paper, we will discuss the principal indications for CT scans in newborns and children in our clinical practice. We will also outline the most-used strategies for dose reduction. Basic knowledge about the various CT techniques is crucial, not only to perform, but also to interpret CT results, thus helping the medical and surgical management of patients.
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Affiliation(s)
- Francesca Raimondi
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, service de radiologie pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France.
| | - Karine Warin-Fresse
- Imagerie cardiovasculaire, fédération des cardiopathies congénitales, CHU de Nantes, 44093 Nantes cedex 1, France
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