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Bigdelu L, Maadarani O, Azari A, Heidari-Bakavoli A, Bitar Z. Double Connection of Left-Sided Partial Anomalous Pulmonary Vein Return in a Young Man. JACC Case Rep 2024; 29:102398. [PMID: 38948494 PMCID: PMC11214385 DOI: 10.1016/j.jaccas.2024.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 07/02/2024]
Abstract
Double connection of partial anomalous pulmonary venous return is a very rare congenital anomaly where at least one pulmonary vein, but not all, drains into the left atrium and systemic venous circulation with subsequent left to right shunt.
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Affiliation(s)
- Leila Bigdelu
- Division of Cardiovascular Medicine, Vascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ossama Maadarani
- Critical Care Unit/Internal Medical Department, Ahmadi Hospital–Kuwait Oil Company, Ahmadi, Kuwait
| | - Ali Azari
- Division of Cardiovascular Medicine, Vascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Zouheir Bitar
- Critical Care Unit/Internal Medical Department, Ahmadi Hospital–Kuwait Oil Company, Ahmadi, Kuwait
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2
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Garg D, Sharma A, Naganur SH, Singhal M. Hitherto Unreported Pattern of Complex Obstructive Partial Anomalous Pulmonary Venous Drainage with Dual Drainage of Accessory Pulmonary Veins. Indian J Radiol Imaging 2024; 34:185-188. [PMID: 38106854 PMCID: PMC10723956 DOI: 10.1055/s-0043-1776107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Partial anomalous pulmonary venous drainage is a congenital cardiac disorder characterized by abnormal drainage of one or more pulmonary veins into the systemic circulation. It can be isolated or associated with other congenital cardiac anomalies, most commonly atrial septal defect and patent ductus arteriosus. The clinical presentation is variable and depends on the degree of shunting and associated cardiac anomalies. Many patients usually remain asymptomatic until late in life. In this article, we presented a complex case of obstructive partial anomalous pulmonary venous drainage with dual drainage of bilateral accessory pulmonary veins with intact interatrial septum in conjunction with a patent ductus arteriosus and a ventricular septal defect. This pattern is incredibly rare and to the best of our knowledge has not been previously reported. Computed tomography played a pivotal role in precisely elucidating the intricate anatomy in this case with a complex pattern of anomalous pulmonary venous drainage.
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Affiliation(s)
- Dollphy Garg
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Sharma
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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3
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Krishnamurthy R, Suman G, Chan SS, Kirsch J, Iyer RS, Bolen MA, Brown RKJ, El-Sherief AH, Galizia MS, Hanneman K, Hsu JY, de Rosen VL, Rajiah PS, Renapurkar RD, Russell RR, Samyn M, Shen J, Villines TC, Wall JJ, Rigsby CK, Abbara S. ACR Appropriateness Criteria® Congenital or Acquired Heart Disease. J Am Coll Radiol 2023; 20:S351-S381. [PMID: 38040460 DOI: 10.1016/j.jacr.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Pediatric heart disease is a large and diverse field with an overall prevalence estimated at 6 to 13 per 1,000 live births. This document discusses appropriateness of advanced imaging for a broad range of variants. Diseases covered include tetralogy of Fallot, transposition of great arteries, congenital or acquired pediatric coronary artery abnormality, single ventricle, aortopathy, anomalous pulmonary venous return, aortopathy and aortic coarctation, with indications for advanced imaging spanning the entire natural history of the disease in children and adults, including initial diagnosis, treatment planning, treatment monitoring, and early detection of complications. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Garima Suman
- Research Author, Mayo Clinic, Rochester, Minnesota
| | | | - Jacobo Kirsch
- Panel Chair, Cleveland Clinic Florida, Weston, Florida
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington
| | | | - Richard K J Brown
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, Utah; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joe Y Hsu
- Kaiser Permanente, Los Angeles, California
| | | | | | | | - Raymond R Russell
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island; American Society of Nuclear Cardiology
| | - Margaret Samyn
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Society for Cardiovascular Magnetic Resonance
| | - Jody Shen
- Stanford University, Stanford, California
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Jessica J Wall
- University of Washington, Seattle, Washington; American College of Emergency Physicians
| | - Cynthia K Rigsby
- Specialty Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Suhny Abbara
- Specialty Chair, University of Texas Southwestern Medical Center, Dallas, Texas
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4
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Bala V P, Barathi S D, Govindarajalou R, M S. Multidetector Computed Tomography (MDCT) Angiography Evaluation of Total Anomalous Pulmonary Venous Connection. Cureus 2023; 15:e46852. [PMID: 37954719 PMCID: PMC10637365 DOI: 10.7759/cureus.46852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiovascular malformation in which all four pulmonary veins anomalously drain into the right atrium (RA) either directly or indirectly. There are four main types based on the site of connection. Any type of TAPVC may be associated with obstruction and presents early in the neonatal period with cyanosis, tachycardia, or respiratory distress. We present four cases of all types of TAPVC and its imaging findings in multidetector computed tomography (MDCT) angiography. Cardiac CT and magnetic resonance imaging (MRI) are very useful in delineating the anatomy and drainage pathway of anomalous pulmonary veins. MDCT angiography is noninvasive and easily available, and rapid image acquisition is possible with high spatial resolution. Since early diagnosis and surgical correction are necessary for the survival of these neonates, rapid image acquisition using MDCT angiography can be preferred over MRI.
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Affiliation(s)
- Priyadharshini Bala V
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Deepak Barathi S
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ramkumar Govindarajalou
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Selvaganesan M
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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5
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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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Well L, Weinrich JM, Meyer M, Kehl T, Salamon J, Rüffer A, Adam G, Herrmann J, Groth M. Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants. ROFO-FORTSCHR RONTG 2020; 193:551-558. [PMID: 33302310 DOI: 10.1055/a-1290-6843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the sensitivity, specificity, and interobserver reliability of high-pitch dual-source computed tomography angiography (CTA) in the detection of anomalous pulmonary venous connection (APVC) in infants with congenital heart defects and to assess the associated radiation exposure. MATERIALS AND METHODS 78 pulmonary veins in 17 consecutively enrolled patients with congenital heart defects (6 females; 11 males; median age: 6 days; range: 1-299 days) were retrospectively included in this study. All patients underwent high-pitch dual-source CTA of the chest at low tube voltages (70 kV). APVC was evaluated independently by two radiologists. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and interobserver agreement were determined. For standard of reference, one additional observer reviewed CT scans, echocardiography reports, clinical reports as well as surgical reports. In cases of disagreement the additional observer made the final decision based on all available information. RESULTS Detection of APVC with high-pitch dual-source CTA revealed a good sensitivity (91 %) and specificity (99 %), with PPV and NPV of 98 % and 97 %. Interobserver agreement was almost perfect (Kappa = 0.84). The median DLP was 3.8 mGy*cm (IQR 3.3-4.7 mGy*cm) and the median radiation dose was 0.33 mSv (IQR 0.26-0.39 mSv). CONCLUSION High-pitch dual-source CTA in infants with congenital heart defects allows for accurate and reliable assessment of APVC at a low radiation dose. KEY POINTS · High-pitch dual-source CTA enables detection of anomalous pulmonary vein connection with high sensitivity in infants.. · Interrater reliability in the detection of anomalous pulmonary vein connection with high-pitch dual-source CTA is almost perfect.. · Radiation dose of high-pitch dual-source CTA in the cardiac examination of infants is low.. CITATION FORMAT · Well L, Weinrich JM, Meyer M et al. Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants. Fortschr Röntgenstr 2021; 193: 551 - 558.
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Affiliation(s)
- Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mathias Meyer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Torben Kehl
- Department of Pediatric Cardiology, University Heart & Vascular Center Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Rüffer
- Department of Pediatric Cardiology, University Heart & Vascular Center Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Department of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Groth
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Department of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Lee JH, Shin HJ, Shin JS. Left Hemitruncus Treated Along with Ventricular Septal Defect in a Neonate. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:414-416. [PMID: 32919443 PMCID: PMC7721518 DOI: 10.5090/kjtcs.20.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 11/24/2022]
Abstract
Hemitruncus arteriosus is a rare cardiovascular malformation in which one of the pulmonary arteries anomalously originates from the aorta. Left hemitruncus arteriosus, defined as the origination of the left pulmonary artery from the aorta, is less common than right hemitruncus arteriosus. In this study, we report the case of a neonate diagnosed with left hemitruncus arteriosus, ventricular septal defect, and atrial septal defect who underwent successful surgical treatment.
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Affiliation(s)
- Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hong Ju Shin
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Seung Shin
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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8
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Arencibia A, Corbera JA, Ramírez G, Díaz-Bertrana ML, Pitti L, Morales M, Jaber JR. Anatomical Assessment of the Thorax in the Neonatal Foal Using Computed Tomography Angiography, Sectional Anatomy, and Gross Dissections. Animals (Basel) 2020; 10:ani10061045. [PMID: 32560487 PMCID: PMC7341306 DOI: 10.3390/ani10061045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to correlate the anatomic features of the normal thorax of neonatal foals identified by CTA, with anatomical sections and gross dissections. Contrast-enhanced transverse CTA images were obtained in three neonatal foals using a helical CT scanner. All sections were imaged with a bone, mediastinal, and lung windows setting. Moreover, cardiac volume-rendered reconstructed images were obtained. After CT imaging, the cadaver foals were sectioned and dissected to facilitate the interpretation of the intrathoracic cardiovascular structures to the corresponding CTA images. Anatomic details of the thorax of neonatal foals were identified according to the characteristics of CT density of the different organic tissues and compared with the corresponding anatomical sections and gross dissections. The information obtained provided a valid anatomic pattern of the thorax of foals, and useful information for CTA studies of this region.
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Affiliation(s)
- Alberto Arencibia
- Departamento de Morfología, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35413 Las Palmas, Spain;
- Correspondence:
| | - Juan Alberto Corbera
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35413 Las Palmas, Spain; (J.A.C.); (M.M.)
| | - Gregorio Ramírez
- Departamento de Anatomía y Anatomía Patológica, Universidad de Murcia, 30100 Murcia, Spain;
| | - María Luisa Díaz-Bertrana
- Hospital Clínico Veterinario, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35413 Las Palmas, Spain; (M.L.D.-B.); (L.P.)
| | - Lidia Pitti
- Hospital Clínico Veterinario, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35413 Las Palmas, Spain; (M.L.D.-B.); (L.P.)
| | - Manuel Morales
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35413 Las Palmas, Spain; (J.A.C.); (M.M.)
| | - José Raduan Jaber
- Departamento de Morfología, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35413 Las Palmas, Spain;
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Chest CTA in children younger than two years - a retrospective comparison of three contrast injection protocols. Sci Rep 2019; 9:18109. [PMID: 31792291 PMCID: PMC6889233 DOI: 10.1038/s41598-019-54498-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/14/2019] [Indexed: 12/26/2022] Open
Abstract
To obtain the highest diagnostic information with least side effects when performing thoracic CT angiography (CTA) is challenging in young children. The current study aims to compare three contrast agent (CA) injection protocols regarding image quality and CA characteristic: a standard CTA, a fixed-bolus delay protocol, and the “microbolus technique (MBT)” developed in our institution. Seventy chest CTA scans of patients (<2 years) were divided into three groups. MBT was applied in group I, the standard protocol in group II and a fixed bolus delay in group III. Objective image quality was assessed by measuring peak enhancement, image noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Two observers scored subjective image quality and artifacts. Significantly lower amounts of CA (mean ± SD) were used in the MBT group compared to Group II (9.0 ± 3.7 ml vs. 12.9 ± 4.5 ml). A lower, but still diagnostic (>400 HU) enhancement was registered in all major thoracic vessels in group I without significant differences regarding SNR and CNR in most regions (p < 0.05). The best scores for image quality and artifacts were reached in group I. All three chest CTA contrast injection protocols offered diagnostic vessel enhancement in young patients. MBT was associated with reduced image artifacts and less injected CA.
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10
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Ali F, Qureshi S, Amanullah M, Atiq M. Accuracy of echocardiography in diagnosing total anomalous pulmonary venous return. Pak J Med Sci 2018; 34:1094-1098. [PMID: 30344556 PMCID: PMC6191797 DOI: 10.12669/pjms.345.15766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: Total anomalous pulmonary venous return is an uncommon cyanotic congenital heart defect. Echocardiography is the initial diagnostic tool. Complimentary non-invasive modalities like cardiac computerized tomographic angiography and cardiac magnetic resonance imaging have replaced the need for cardiac catheterization in difficult cases. This study aimed to determine the accuracy of echocardiography in diagnosing total anomalous pulmonary venous return, and to determine the factors that may decrease its sensitivity. Methods: This was a cross-sectional study conducted at the Aga Khan University Hospital Karachi, Pakistan from January 2010 to August 2016. All patients who were diagnosed with Total anomalous pulmonary venous return on echocardiography and had subsequent confirmation either on cardiac CT angiography or surgery were included. The diagnostic accuracy of echocardiography was expressed as sensitivity. Previously described taxonomy was used to define diagnostic error. Univariate and multivariate analysis were done by logistic regression OR (95% CI) were reported to identify factors causing the diagnostic error. Results: High diagnostic sensitivity (81%) was found in isolated total anomalous pulmonary venous return and low (27%) in heterotaxy and mixed (20%) varieties. Poor acoustic windows and right isomerism were found to be significant factors responsible for the diagnostic error on multivariate analysis. Conclusion: Echocardiography can diagnose isolated total anomalous pulmonary venous return with high accuracy. Use of additional modalities may be required for a complete diagnosis in cases with mixed variety, heterotaxy and poor acoustic windows.
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Affiliation(s)
- Fatima Ali
- Dr. Fatima Ali, FCPS (Pediatrics). Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Sonia Qureshi
- Dr. Sonia Qureshi, FCPS (Pediatrics). Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muneer Amanullah
- Dr. Muneer Amanullah, FRCS (General Surgery RCS Edinburgh). Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Mehnaz Atiq
- Dr. Mehnaz Atiq, FCPS (Pediatrics), FCPS (Pediatric Cardiology). Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
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11
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Abstract
Cardiovascular CT (CCT) is an important imaging modality in congenital and acquired paediatric heart disease. Technological advances have resulted in marked improvements in spatial and temporal resolution of CCT with a concomitant increase in speed of data acquisition and a decrease in radiation dose. This has elevated CCT from being sparingly used to an essential diagnostic tool in the daily multimodality imaging practice alongside echocardiography, cardiovascular MR and invasive angiography. The application of CCT in paediatric congenital and acquired heart disease can be both technically and diagnostically challenging. This review highlights important considerations for current state of the art CCT across the spectrum of heart disease encountered in children.
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Affiliation(s)
- Kristian H Mortensen
- 1 Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Oliver Tann
- 1 Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
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12
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Onbas O, Koplay M, Kandis H, Besir FH, Erdogmus B. Total Anomalous Pulmonary Venous Connection Draining into the Portal Vein in a 2-Month-Old Infant: Multidetector Computed Tomography Angiography Diagnosis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiac anomaly in which the pulmonary veins fail to connect with the left atrium and connect directly to the right atrium or to one of the systemic veins. Early diagnosis and surgical correction is highly important for survival. In the evaluation of TAPVC, imaging methods such as echocardiography, computed tomography (CT) angiography, magnetic resonance (MR) angiography, and catheter angiography have been used. We reported a rare case of infracardiac type of TAPVC draining into the portal vein at 2-mounth-old infant who was admitted to the hospital with shortness of breath and mild cyanosis. The images demonstrating TAPVC between the portal vein and the pulmonary veins with multidetector computed tomography (MDCT) angiography were also shown.
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Affiliation(s)
| | - M Koplay
- Selcuk University School of Selcuklu Medicine, Department of Radiology, Konya, Turkey
| | - H Kandis
- Duzce University School of Medicine, Department of Emergency, Duzce, Turkey
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13
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Abstract
Although Doppler analysis of pulmonary veins (PVs) is crucial in the assessment of cardiac hemodynamics, there is controversy regarding individual anatomical PV imaging with transthoracic echocardiography (TTE). This report is a discussion of how to image PVs accurately using TTE. To resolve any contradiction, multiple TTE images were obtained during the selective catheterization of the PV in patients undergoing atrial fibrillation ablation procedure. Fluoroscopic images were used as a reference for the identification of each PV and simultaneous echocardiographic imaging of the catheter positioned in the distal PV was used for accurate anatomical localization of the ostium and distal part of the PV.
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14
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Turkvatan A, Tola HT, Ayyildiz P, Ozturk E, Ergul Y, Guzeltas A. Total Anomalous Pulmonary Venous Connection in Children: Preoperative Evaluation with Low-Dose Multidetector Computed Tomographic Angiography. Tex Heart Inst J 2017; 44:120-126. [PMID: 28461797 DOI: 10.14503/thij-15-5725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report the results of our retrospective evaluation, from February 2011 through August 2014, of the anatomic features of total anomalous pulmonary venous connection (TAPVC) and its associated cardiovascular anomalies in a pediatric population. In all 43 patients under study (23 female; average age, 9 mo [range, 4 d-7.1 yr]), these examinations had been performed with a dual-source 256-detector scanner. The type of TAPVC, the presence of obstruction, and the association with other cardiovascular anomalies were investigated and recorded. In accordance with the absence or presence of these accompanying anomalies, patients were subdivided into 2 groups: isolated and complex. In the 43 patients, 22 (51%) TAPVCs were supracardiac, 10 (23%) were cardiac, 6 (14%) were infracardiac, and 5 (12%) were mixed. Obstruction was detected in 7 patients. Seventeen patients were in the isolated group and 26 in the complex group. The diagnostic agreements between multidetector computed tomographic angiographic and surgical results were 100% in both the isolated and complex groups. The overall average effective radiation dose was 0.66 mSv (range, 0.15-1.11 mSv); and it was 0.52 mSv (range, 0.12-0.72 mSv) in patients younger than 1 year of age. We conclude that computed tomographic angiography with a dual-source 256-slice multidetector scanner is a reliable imaging method that enables, despite lower radiation doses, the detailed and comprehensive anatomic imaging of TAPVC in neonates and children.
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15
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Aluja Jaramillo F, Hernandez C, Garzón JP, Sánchez Herrera AP, Velasco Morales ML. Infracardiac type total anomalous pulmonary venous return with obstruction and dilatation of portal vein. Radiol Case Rep 2017; 12:229-232. [PMID: 28491157 PMCID: PMC5417730 DOI: 10.1016/j.radcr.2017.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/03/2017] [Accepted: 01/13/2017] [Indexed: 11/29/2022] Open
Abstract
Total anomalous pulmonary venous return (TAPVR), also known as total anomalous pulmonary venous connection, is a congenital cardiovascular malformation that presents itself in the neonatal period, with cyanosis and tachypnea. There are 4 types of TAPVR with the mixed type being the least common. Any type of TAPVR may be associated with obstruction as result of flow redirection through the liver parenchyma before it may return to the heart, but infracardiac is the most common one. We report a case of a 10-hour-old female, with a mixed (cardiac and infracardiac) TAVPR with obstruction, that showed drainage to the coronary sinus and the portal vein, as the other classic findings in TAVPR, made with computed tomography angiography and echocardiogram. The patient was taken to surgical repair, but unfortunately died during the procedure because of multiple complications.
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Affiliation(s)
| | - Cristian Hernandez
- Radiology Department, Universidad de La Sabana, Dg. 115a #70C - 75, Bogotá, Colombia
| | - Juan Pablo Garzón
- Radiology Department, Universidad de La Sabana, Dg. 115a #70C - 75, Bogotá, Colombia
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Lewis AJ, Mogollon IR, Dávila F, Nuñez F, Cajica G. Conexión venosa anómala total infracardiaca infradiafragmática; reporte de un caso. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ross FJ, Joffe D, Latham GJ. Perioperative and Anesthetic Considerations in Total Anomalous Pulmonary Venous Connection. Semin Cardiothorac Vasc Anesth 2016; 21:138-144. [PMID: 27694572 DOI: 10.1177/1089253216672012] [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] [Indexed: 11/17/2022]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a potentially devastating form of congenital heart disease in which all pulmonary blood flow returns to the systemic venous circulation rather than the left atrium. Anomalous pulmonary venous flow may be obstructed at birth, and affected infants present with severe cyanosis and poor cardiac output unresponsive to standard resuscitation with prostaglandin. Obstructed TAPVC remains one of the few indications for emergent neonatal cardiac surgery. This review will discuss the physiology and perioperative management of isolated TAPVC without associated cardiac lesions.
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Affiliation(s)
- Faith J Ross
- 1 Seattle Children's Hospital, Seattle, WA, USA.,2 University of Washington School of Medicine, Seattle, WA, USA
| | - Denise Joffe
- 1 Seattle Children's Hospital, Seattle, WA, USA.,2 University of Washington School of Medicine, Seattle, WA, USA
| | - Gregory J Latham
- 1 Seattle Children's Hospital, Seattle, WA, USA.,2 University of Washington School of Medicine, Seattle, WA, USA
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Positional Relationship Between the Pulmonary Venous Confluence-Vertical Vein and Atria in Infracardiac Total Anomalous Pulmonary Venous Connection. Pediatr Cardiol 2016; 37:372-7. [PMID: 26481116 DOI: 10.1007/s00246-015-1286-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
To explore the positional relationship between the pulmonary venous confluence-venous vein (PVC-VV) and both the atria in infracardiac total anomalous pulmonary venous connection (iTAPVC), using two-dimensional (2D) computerized tomography (CT) reconstruction. Through the 2D reconstruction of enhanced cardiac CT images of patients with iTAPVC, the projection of PVC-VV on coronal axial images was acquired and its location on the bilateral atrial splice was analyzed. Sagittal axial reconstruction was used to identify which atrium had a precise anterior-posterior positional relationship with PVC-VV. The type of iTAPVC, where the projection of PVC-VV was lying on the left atrium, and the left atrium had a precise anterior-posterior positional relationship with PVC-VV, was classified as the left atrial type. If the projection of PVC-VV was lying on the right atrium and the right atrium had a precise anterior-posterior positional relationship with PVC-VV, it was classified as the right atrial type. Finally, if the projection of PVC-VV was lying in the middle of the bilateral atria, and both the atria had precise anterior-posterior positional relationship with PVC-VV, it was referred to as the bilateral atrial type. Upon analysis of the 22 enhanced cardiac CT images, 6 were the left atrial type (27.27 %), 9 were right atrial type (40.91 %), while 7 were of the bilateral atrial type (31.82 %). The positional relationship between PVC-VV and the bilateral atria are variable, and iTAPVC classification using 2D CT reconstruction is an invaluable tool in designing the surgical approaches in iTAPVC.
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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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Mixed Supra- and Intracardiac Totally Anomalous Pulmonary Venous Connection in an Adult Female: Pre- and Postoperative Evaluation with Emphasis on MDCT Angiographic Advantages. Heart Lung Circ 2015; 24:e188-92. [DOI: 10.1016/j.hlc.2015.06.822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 06/08/2015] [Indexed: 11/17/2022]
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21
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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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22
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Mousa TM, Akinseye OA, Kerwin TC, Akinboboye OO. A Rare Association of Sinus Venosus-Type Atrial Septal Defect and Persistent Left Superior Vena Cava Detected by Transthoracic Echocardiography and Cardiac Magnetic Resonance Imaging. Am J Case Rep 2015; 16:528-31. [PMID: 26262994 PMCID: PMC4536868 DOI: 10.12659/ajcr.894394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Tarek M. Mousa
- Department of Cardiology, Queens Heart Institute, Laurelton, NY, USA
| | - Oluwaseun A. Akinseye
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, NY, USA
| | - Todd C. Kerwin
- Department of Cardiology, The New York Hospital Medical Center of Queens/Cornell University Medical College, Flushing, NY, USA
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Goo HW, Park SH, Koo HJ, Cho YH, Lee E. Atresia of the bilateral pulmonary veins: a rare and dismal anomaly identified on cardiac CT. Pediatr Radiol 2014; 44:942-7. [PMID: 24535116 DOI: 10.1007/s00247-014-2900-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/22/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Imaging findings of bilateral pulmonary vein atresia have not been described. OBJECTIVE To describe cardiac CT findings and clinical outcomes of bilateral pulmonary vein atresia. MATERIALS AND METHODS Three newborns with bilateral pulmonary vein atresia were encountered at our institution during a period of 8 years. We evaluated prenatal echocardiographic findings, clinical presentations, postnatal echocardiographic findings, chest radiographic findings, cardiac CT findings and clinical outcomes. RESULTS All newborns presented immediately after birth with severe cyanosis, respiratory distress and acidosis that were unresponsive to medical management. Prenatal and postnatal echocardiographic studies and chest radiography were misleading, inconclusive or nonspecific in making the diagnosis in these children; however cardiac CT clearly demonstrated atresia of the bilateral pulmonary veins with multiple small mediastinal collateral veins and pulmonary edema. Surgical treatments were not feasible for this anomaly. Their clinical outcomes were universally dismal and all infants died within 3 days. CONCLUSION Cardiac CT provides an accurate diagnosis of bilateral pulmonary vein atresia and leads to prompt treatment decision in these children.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea,
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Saake M, Lell MM, Rompel O, Gloeckler M, May M, Eller A, Achenbach S, Uder M, Wuest W. Contrast medium application in pediatric high-pitch cardiovascular CT angiography: Manual or power injection? J Cardiovasc Comput Tomogr 2014; 8:315-22. [DOI: 10.1016/j.jcct.2014.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/14/2014] [Accepted: 05/08/2014] [Indexed: 11/27/2022]
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Yoshimura N, Fukahara K, Yamashita A, Doki Y, Takeuchi K, Higuma T, Senda K, Toge M, Matsuo T, Nagura S, Aoki M, Sakata K, Obi H. Current topics in surgery for isolated total anomalous pulmonary venous connection. Surg Today 2014; 44:2221-6. [DOI: 10.1007/s00595-014-0877-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
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Shen Q, Pa M, Hu X, Wang J. Role of plain radiography and CT angiography in the evaluation of obstructed total anomalous pulmonary venous connection. Pediatr Radiol 2013; 43:827-35. [PMID: 23341089 DOI: 10.1007/s00247-012-2609-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 11/17/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Obstructed total anomalous pulmonary venous connection (TAPVC) is frequently misdiagnosed as pulmonary disease and without operative correction early death is common. It is important to make a correct diagnosis before surgery. OBJECTIVE The purpose of this study was to describe the chest radiographic features of obstructed TAPVC and compare CT angiography with transthoracic echocardiography in the evaluation of obstructed TAPVC. MATERIALS AND METHODS Eighteen children with obstructed TAPVC were assessed. Their clinical and imaging data were retrospectively reviewed. The characteristic radiographic findings were analyzed and compared with surgical results, and the diagnostic accuracy of CT angiography and transthoracic echocardiography was evaluated in terms of pulmonary venous drainage and obstruction detection. RESULTS The common radiographic features included pulmonary venous congestion or edema or both (16 of 18 cases, 89%), and absence of cardiomegaly (12 of 18 cases, 67%). CT angiography correctly diagnosed TAPVC and clearly revealed the draining sites in all children (five with supracardiac TAPVC, three with cardiac TAPVC, eight with infracardiac TAPVC and two with mixed TAPVC). The diagnostic agreement between CT angiography and surgery was 100%. Transthoracic echocardiography only correctly revealed the draining sites in 11 children (5 with supracardiac TAPVC, 2 with cardiac TAPVC and 4 with infracardiac TAPVC). The diagnostic agreement between transthoracic echocardiography and surgery was 61%. The diagnostic accuracy of CT angiography was higher than that of transthoracic echocardiography (P = 0.0156). Thirty-four sites of obstruction were correctly detected by CT angiography (11 in the mediastinum, 1 at the diaphragmatic level, 9 below the diaphragm and 13 stenotic individual pulmonary veins in the lung). The diagnostic agreement between CT angiography and surgery was 92%. Transthoracic echocardiography only correctly detected 15 sites of obstruction (11 in the mediastinum, 1 at the diaphragmatic level and 3 below the diaphragm). The diagnostic agreement between transthoracic echocardiography and surgery was 41%. The rate of detection for sites of obstruction with transthoracic echocardiography was much lower than that of CT angiography (P = 0.0002). CONCLUSION In children with obstructed TAPVC, plain radiographs usually show a characteristic pattern of pulmonary venous congestion or edema, or both, and a normal cardiac silhouette. CT angiography is superior to transthoracic echocardiography in the evaluation of pulmonary venous drainage and obstruction, especially in children with infracardiac and mixed TAPVC.
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Affiliation(s)
- Quanli Shen
- Department of Radiology, Children's Hospital, Fudan University, 399 Wanyuan St., Shanghai, China, 201102
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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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Non-ECG-gated MDCTA of infracardiac total anomalous pulmonary venous connection in neonates and young infants. Herz 2013; 38:539-43. [DOI: 10.1007/s00059-012-3728-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/25/2012] [Accepted: 10/28/2012] [Indexed: 11/30/2022]
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Cardiovascular MR imaging findings of total anomalous pulmonary venous connection to the portal vein in a patient with right atrial isomerism. Wien Klin Wochenschr 2012; 124:848-50. [PMID: 23238601 DOI: 10.1007/s00508-012-0304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiovascular anomaly in which the pulmonary veins fail to join to the left atrium and drain directly to the right atrium or to one of the systemic veins. This anomaly is frequently seen together with complex cardiac anomalies especially as a part of right atrial isomerism syndrome. Atrial isomerism is called that the same morphological structure of both atria. We reported a very rare case demonstrating TAPVC between the portal vein and the pulmonary veins in a patient with right atrial isomerism by magnetic resonance imaging.
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Katre R, Burns SK, Murillo H, Lane MJ, Restrepo CS. Anomalous Pulmonary Venous Connections. Semin Ultrasound CT MR 2012; 33:485-99. [DOI: 10.1053/j.sult.2012.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Liu J, Wu Q, Xu Y, Bai Y, Liu Z, Li H, Zhu J. Role of MDCT angiography in the preoperative evaluation of anomalous pulmonary venous connection associated with complex cardiac abnormality. Eur J Radiol 2012; 81:1050-6. [DOI: 10.1016/j.ejrad.2011.01.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 01/17/2011] [Accepted: 01/28/2011] [Indexed: 11/26/2022]
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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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Siripornpitak S, Pornkul R, Khowsathit P, Layangool T, Promphan W, Pongpanich B. Cardiac CT angiography in children with congenital heart disease. Eur J Radiol 2011; 82:1067-82. [PMID: 22196744 DOI: 10.1016/j.ejrad.2011.11.042] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiac imaging plays an important role in both congenital and acquired heart diseases. Cardiac computed tomography (angiography) cCT(A) is a non-invasive, increasingly popular, complementary modality to echocardiography in evaluation of congenital heart diseases (CHD) in children. Despite radiation exposure, cCT(A) is now commonly used for evaluation of the complex CHD, giving information of both intra-cardiac and extra-cardiac anatomy, coronary arteries, and vascular structures. This review article will focus on the fundamentals and essentials for performing cCT(A) in children, including radiation dose awareness, basic techniques, and strengths and weaknesses of cCT(A) compared with cardiac magnetic resonance imaging (cMRI), and applications. The limitations of this modality will also be discussed, including the CHD for which cMRI may be substituted.
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Affiliation(s)
- Suvipaporn Siripornpitak
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Nakagawa M, Hara M, Sakurai K, Ohashi K, Asano M, Shibamoto Y. Usefulness of electrocardiography-gated dual-source computed tomography for evaluating morphological features of the ventricles in children with complex congenital heart defects. Jpn J Radiol 2011; 29:540-6. [PMID: 21927995 DOI: 10.1007/s11604-011-0594-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 03/28/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Improved time resolution using dual-source computed tomography (DSCT) enabled adaptation of electrocardiography (ECG)-gated cardiac CT for children with a high heart rate. In this study, we evaluated the ability of ECG-gated DSCT (ECG-DSCT) to depict the morphological ventricular features in patients with congenital heart disease (CHD). MATERIALS AND METHODS Between August 2006 and March 2010, a total of 66 patients with CHD (aged 1 day to 9 years, median 11 months) were analyzed using ECG-DSCT. The type of anomaly was ventricular septal defect (VSD) in 32 (malaligned type in 20, perimembranous type in 7, supracristal type in 3, muscular type in 2), single ventricle (SV) in 11, and corrected transposition of the great arteries (cTGA) in 3. All patients underwent ECG-DSCT and ultrasonography (US). We evaluated the accuracy of diagnosing the type of VSD. For the cases with SV and cTGA, we evaluated the ability to depict anatomical ventricular features. RESULTS In all 32 cases of VSD, DSCT could confirm the VSD defects, and the findings were identical to those obtained by US. Anatomical configurations of the SV and cTGA were correctly diagnosed, similar to that on US. CONCLUSION Our study suggests that ECG-DSCT can clearly depict the configuration of ventricles.
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Affiliation(s)
- Motoo Nakagawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
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Glatz AC, Zhu X, Gillespie MJ, Hanna BD, Rome JJ. Use of angiographic CT imaging in the cardiac catheterization laboratory for congenital heart disease. JACC Cardiovasc Imaging 2011; 3:1149-57. [PMID: 21071003 DOI: 10.1016/j.jcmg.2010.09.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 08/26/2010] [Accepted: 09/16/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to retrospectively evaluate our initial experience using angiographic computed tomography (ACT) in a pediatric cardiac catheterization laboratory. BACKGROUND ACT provides cross-sectional CT images from a rotational angiography run using a C-arm mounted flat-panel detector in the interventional suite. A 3-dimensional (3D) angiographic image can be created from the CT volume set and used in real time during the procedure. To our knowledge, its use has never previously been described for congenital heart disease. METHODS 3D reconstructions were created and we retrospectively reviewed cases during our first year of ACT use. Images obtained were independently evaluated to determine their diagnostic utility. Radiation dose reduction protocols were defined using phantom testing and radiation dose calculation. RESULTS ACT was used during 41 cardiac catheterizations in patients at a median age of 5.1 years (range: 0.4 to 58.8 years) for evaluation of: right ventricular outflow tract (RVOT)/central pulmonary arteries (PAs) in 20; cavopulmonary connection (CPC) in 11; pulmonary veins in 5; distal PAs in 4; and other locations in 5. Four subjects had 2 anatomic areas studied by ACT. The mean contrast volume for ACT was 1.2 ± 0.4 ml/kg. Diagnostic-quality imaging was obtained in 71% of cases: 13/20 RVOT/central PAs; 9/11 CPC; 4/5 pulmonary veins; 2/4 distal PAs; and 4/5 others. In 12 cases, ACT contributed to clinical outcomes beyond standard angiography. Radiation dose reduction protocols allowed ACT to be comparable in exposure to a standard biplane cineangiogram. CONCLUSIONS Diagnostic-quality imaging can be obtained using ACT in 71% of cases without a significant increase in contrast or radiation exposure. In certain cases, ACT provides additional anatomic detail and may aid complex catheter manipulations. Future work is needed to continue to define applications of this new technology.
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Affiliation(s)
- Andrew C Glatz
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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Amat F, Le Bret E, Sigal-Cinqualbre A, Coblence M, Lambert V, Rohnean A, Paul JF. Diagnostic accuracy of multidetector spiral computed tomography for preoperative assessment of sinus venosus atrial septal defects in children. Interact Cardiovasc Thorac Surg 2011; 12:179-82. [DOI: 10.1510/icvts.2010.251298] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Kimura LY, Fernandes GSDS, Nobrega KTDM, Gabure LAG, Cattani CAM, Silva JPD, Furlanetto BHS. Angiotomografia com múltiplos detectores no diagnóstico de drenagem venosa pulmonar anômala: experiência inicial. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000600004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Demonstrar que a angiotomografia computadorizada com múltiplos detectores é um método efetivo e não invasivo para o diagnóstico de drenagem venosa pulmonar anômala. MATERIAIS E MÉTODOS: Estudo retrospectivo de 2.905 angiotomografias computadorizadas com múltiplos detectores cardíacas realizadas em nosso serviço no período de julho de 2003 a novembro de 2007. Destas, 393 foram destinadas para avaliar cardiopatias congênitas e as 2.512 restantes, para analisar as artérias coronárias. RESULTADOS: Foram encontrados 21 casos de drenagem venosa pulmonar anômala, sendo 7 (33,3%) do tipo total e 14 (66,7%) do tipo parcial. Das drenagens venosas pulmonares anômalas totais, três foram do tipo supracardíaco, três do tipo infracardíaco e uma do tipo cardíaco. CONCLUSÃO: A angiotomografia computadorizada com múltiplos detectores tem demonstrado fundamental importância no diagnóstico destas anomalias, principalmente por se tratar de método não invasivo capaz de analisar estruturas intra e extracardíacas e por permitir um estudo completo da anatomia torácica, contribuindo sobremaneira na conduta cirúrgica e, consequentemente, no prognóstico destes pacientes, especialmente por diagnosticar malformações não suspeitadas clinicamente
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Affiliation(s)
| | | | | | | | | | - José Pedro da Silva
- Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, Brasil
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Mixed-type total anomalous pulmonary venous connection. Pediatr Cardiol 2010; 31:929-30. [PMID: 20490476 DOI: 10.1007/s00246-010-9728-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 05/05/2010] [Indexed: 12/20/2022]
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Shaheen F, Gojwari TA, Andrabi M, Sofi S, Singh M. 64-slice CT imaging in a case of total anomalous pulmonary venous circulation. Indian J Radiol Imaging 2009; 19:54-6. [PMID: 19774141 PMCID: PMC2747419 DOI: 10.4103/0971-3026.45346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
For long, catheter angiography has been the investigation of choice for the diagnosis of congenital anomalies of the heart such as total anomalous pulmonary venous circulation (TAPVC). In the last few years, MRI and multislice CT scan have also been introduced for this purpose. We report a case where 64-slice CT scan was found very useful in the evaluation of TAPVC.
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Oh KH, Choo KS, Lim SJ, Lee HD, Park JA, Jo MJ, Sung SC, Chang YH, Jeong DW, Kim S. Multidetector CT evaluation of total anomalous pulmonary venous connections: comparison with echocardiography. Pediatr Radiol 2009; 39:950-4. [PMID: 19506848 DOI: 10.1007/s00247-009-1309-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 04/15/2009] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although echocardiography is the first-line imaging modality in the diagnosis of total anomalous pulmonary venous connection (TAPVC), multidetector CT (MDCT) could have advantages in the diagnosis of TAPVC in certain cases. OBJECTIVE To compare MDCT with echocardiography in the evaluation of TAPVC. MATERIALS AND METHODS Enrolled in the study were 23 patients with surgically proven TAPVC. The echocardiography and MDCT findings were independently interpreted by a paediatric cardiologist and cardiac radiologist in terms of: (1) the drainage site of the common pulmonary vein, (2) stenosis of the vertical vein, and (3) the course of the atypical vessel into the systemic vein in the case of vertical vein stenosis. The findings from both modalities were correlated with the results obtained at surgery (n=22) or autopsy (n=1). RESULTS In all patients, MDCT correctly depicted the drainage site of the common pulmonary vein, stenosis of the vertical vein and the course of the atypical vessel into the systemic vein (sensitivity 100%, specificity 100%). The specificity of echocardiography was 100% for the three defined findings. The sensitivity of echocardiography, however, was 87%, 71% and 0%, respectively. CONCLUSION MDCT can facilitate the diagnosis of TAPVC in certain cases.
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Affiliation(s)
- Ki Ho Oh
- Department of Radiology, Medical Institute, Pusan National University Hospital, Pusan 602-739, Republic of Korea
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Abstract
Total anomalous pulmonary venous return (TAPVR) is an uncommon cause of cyanotic congenital heart disease in the neonatal period. This diagnosis is often made by echocardiography. We present two cases where echocardiography was not confirmatory. Computerized tomography (CT) scan of the chest and abdomen with contrast was performed instead of cardiac catheterization to establish the diagnosis. We suggest that CT with contrast is a noninvasive modality to obtain anatomic details of pulmonary venous drainage in TAPVR when echocardiography is inconclusive.
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Role of CT in the Evaluation of Congenital Cardiovascular Disease in Children. AJR Am J Roentgenol 2009; 192:1219-31. [PMID: 19380544 DOI: 10.2214/ajr.09.2382] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Comparison of 16-multidetector-row computed tomography and angiocardiography for evaluating the central pulmonary artery diameter and pulmonary artery index in children with congenital heart disease. ACTA ACUST UNITED AC 2008; 26:337-42. [DOI: 10.1007/s11604-008-0237-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Accepted: 02/21/2008] [Indexed: 10/21/2022]
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Affiliation(s)
- Marilyn J Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd., Saint Louis, MO 63110, USA.
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Wang XM, Wu LB, Sun C, Liu C, Chao BT, Han B, Zhang YT, Chen HS, Li ZJ. Clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot. Eur J Radiol 2007; 64:296-301. [PMID: 17399932 DOI: 10.1016/j.ejrad.2007.02.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 02/16/2007] [Accepted: 02/23/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot. METHODS Eighteen patients with diagnosed Tetralogy of Fallot underwent cardiac CT angiography with 64-slice CT (CTA). Two- and three-dimensional images were used for diagnosing in all cases by means of MPR (coronal, sagital and oblique), cMPR, MIP and VRT. RESULTS All patients had ventricular septal defect, pulmonary stenosis and hypertrophy of right ventricle. The morphologic features of Tetralogy of Fallot were equal to echocardiography. Patent ductus arteriosus (PDA) were detected on eight patients. Main coronary artery branches and partial sub-branches were visualized in all patients. Abnormal coronary arteries were found in seven cases: both left and right main coronary artery arising from the right aortic sinus one case, right main coronary artery and circumflex (CX) arising from the right aortic sinus one case, left anterior descending (LAD) and CX arising from left aortic sinus directly one case, left and right coronary artery arising from back and front of the aortic sinus, respectively, three cases. Pulmonary artery branch stenosis was found in 12 cases and branch pulmonary artery dilation noticed in 1 case. Double superior vena cava was also found in one case. According to the surgery the diagnostic accuracy of CT and Echocardiography was 95.45 and 83.33%, respectively. CONCLUSION Two- and three-dimensional 64-slice CTA not only show the overall anatomical structure of the heart, but also show coronary and pulmonary arteries. With these results, evaluation of coronary anomalies and pulmonary artery stenosis with 64-MSCT is extremely valuable for planning the operative procedure on the patients with Tetralogy of Fallot.
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Affiliation(s)
- Xi-Ming Wang
- Tianjin Medical University, Tianjin City, PR China.
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Vasquez JC, DeLaRosa J, Montesinos E, Rosales E, Duenas R, Rotta A, Leon JJ. Total anomalous pulmonary venous return and Mayer-Rokitansky-Kuster-Hauser syndrome. Int J Cardiol 2007; 128:e104-6. [PMID: 17689726 DOI: 10.1016/j.ijcard.2007.05.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 05/26/2007] [Indexed: 11/28/2022]
Abstract
We present an adult woman with total anomalous pulmonary venous return (TAPVR) and Mayer-Rokitansky-Kuster-Hauser syndrome that was diagnosed intraoperatively during a planned atrial secundum defect closure. Surgical repair of TAPVR was performed with good outcome.
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Uçar T, Fitoz S, Tutar E, Atalay S, Uysalel A. Diagnostic tools in the preoperative evaluation of children with anomalous pulmonary venous connections. Int J Cardiovasc Imaging 2007; 24:229-35. [PMID: 17597422 DOI: 10.1007/s10554-007-9246-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 06/12/2007] [Indexed: 12/20/2022]
Abstract
Pulmonary venous abnormalities are generally diagnosed by echocardiography and often confirmed by cardiac catheterization. Although angiography has been the gold standard for evaluation it carries certain inherent risks, especially in small and sick infants. In this study we retrospectively assessed the utility of magnetic resonance angiography (MRA) and computed tomography angiography (CTA) in the evaluation of pulmonary venous abnormalities in pediatric patients. The results were compared with operative findings. We reviewed nine patients with total APVC and four with partial APVC. Twelve patients were infant (age range: 1 day to 8 months) and the other was 16 years old. MRA and/or CTA clearly visualized the anomalous drainage of pulmonary veins in all patients. Cardiac catheterization was performed five patients with one total anomalous pulmonary venous connection and four with partial anomalous pulmonary venous connection. Ten patients were operated on. Diagnoses of patients were confirmed by operative findings. In Conclusions, MR and CT angiography allow detailed and comprehensive evaluation of the APVC and are good diagnostic modalities for use in the preoperative assessment of the anomaly in pediatric patients.
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Affiliation(s)
- Tayfun Uçar
- Department of Pediatric Cardiology, Ankara University School of Medicine, Ankara, Turkey.
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