Dual Phase Multidetector Computed Tomography Angiography in Evaluation of Pulmonary Arteries and Collateral Vessels in Children with Cyanotic Congenital Heart Diseases

Overview

Journal Med J Armed Forces India

Specialty General Medicine

Date 2024 Dec 30

PMID 39734834

Authors

Kapil Semalti

Vivek Sharma

Vivek Kumar

Sandhya Aneja

Ashish K Simalti

Akash Malik

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of this paper is to compare the efficacy of dual-phase multidetector computed tomography angiography (CTA) with transthoracic echocardiogram (TTE) and cardiac catheterization angiography (CCA) in evaluation of pulmonary arteries and collateral vessels, major aortopulmonary collateral arteries (MAPCAs) in children with cyanotic congenital heart diseases.

Methods: The study was a prospective observational study where 32 pediatric patients (18 males, 14 females and age range 2-116 months) with cyanotic congenital heart diseases (CCHD) were included. All patients underwent TTE, CTA, and CCA. The findings of CTA in evaluation of pulmonary arteries and MAPCAs were compared with TTE and correlated with CCA findings.

Results: All CTA studies were adequate except in one (3.1%) case in which main pulmonary artery and left pulmonary artery were not visualized on any of the three modalities. Right pulmonary artery anatomy was not clear or not demonstrated in four cases (12.6%) on CCA, whereas CTA was able to demonstrate pulmonary arteries in these cases. TTE was inadequate in 11 cases (34.3 %) in which one or more pulmonary artery was not clearly visualized. In cases with good pulmonary artery diameter (corresponding to Z score between 1 to 2) statistically significant (P < 0.001) correlation was found between pulmonary artery diameters, McGoon ratio, Nakata index, and Z-scores calculated for pulmonary arteries on all three modalities. There was concordance between CTA and CCA in assessment of MAPCAs and patent ductus arteriosus (PDA), whereas TTE failed to demonstrate MAPCAs in six cases (18.8%).

Conclusion: CTA was found to be superior to TTE and CCA for the assessment of pulmonary arteries and MAPCAs. CTA is also superior to TTE in the detection of extracardiac anomalies.

References

Sakai S, Murayama S, Soeda H, Furuya A, Ono M, Ro T . Unilateral proximal interruption of the pulmonary artery in adults: CT findings in eight patients. J Comput Assist Tomogr. 2002; 26(5):777-83. DOI: 10.1097/00004728-200209000-00019. View

Cheng Z, Wang X, Duan Y, Wu L, Wu D, Chao B . Low-dose prospective ECG-triggering dual-source CT angiography in infants and children with complex congenital heart disease: first experience. Eur Radiol. 2010; 20(10):2503-11. DOI: 10.1007/s00330-010-1822-7. View

Goo H, Park I, Ko J, Kim Y, Seo D, Yun T . CT of congenital heart disease: normal anatomy and typical pathologic conditions. Radiographics. 2003; 23 Spec No:S147-65. DOI: 10.1148/rg.23si035501. View

Gaca A, Jaggers J, Dudley L, Bisset 3rd G . Repair of congenital heart disease: a primer--Part 2. Radiology. 2008; 248(1):44-60. DOI: 10.1148/radiol.2481070166. View

Nakata S, Imai Y, Takanashi Y, Kurosawa H, Tezuka K, Nakazawa M . A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg. 1984; 88(4):610-9. View

Bu G, Miao Y, Bin J, Deng S, Liu T, Jiang H . Comparison of 128-Slice Low-Dose Prospective ECG-Gated CT Scanning and Trans-Thoracic Echocardiography for the Diagnosis of Complex Congenital Heart Disease. PLoS One. 2016; 11(10):e0165617. PMC: 5082860. DOI: 10.1371/journal.pone.0165617. View

Xu J, Zhao H, Wang X, Bai Y, Liu L, Liu Y . Accuracy, image quality, and radiation dose of prospectively ECG-triggered high-pitch dual-source CT angiography in infants and children with complex coarctation of the aorta. Acad Radiol. 2014; 21(10):1248-54. DOI: 10.1016/j.acra.2014.04.019. View

Mertens L, Friedberg M . The gold standard for noninvasive imaging in congenital heart disease: echocardiography. Curr Opin Cardiol. 2009; 24(2):119-24. DOI: 10.1097/HCO.0b013e328323d86f. View

Mercan A, Sezgin A, Tokel K, Tasdelen A, Ikizler C, Ekici E . The role of pulmonary artery anatomy in repair of tetralogy of Fallot. Turk J Pediatr. 2001; 43(1):34-7. View

10.

Rao P . Diagnosis and management of cyanotic congenital heart disease: part I. Indian J Pediatr. 2009; 76(1):57-70. DOI: 10.1007/s12098-009-0030-4. View

11.

Miranovic V . The incidence of congenital heart disease: previous findings and perspectives. Srp Arh Celok Lek. 2014; 142(3-4):243-8. DOI: 10.2298/sarh1404243m. View

12.

Adamson G, McElhinney D, Zhang Y, Feinstein J, Peng L, Ma M . Angiographic Anatomy of Major Aortopulmonary Collateral Arteries and Association With Early Surgical Outcomes in Tetralogy of Fallot. J Am Heart Assoc. 2020; 9(24):e017981. PMC: 7955371. DOI: 10.1161/JAHA.120.017981. View

13.

Westra S, Hill J, Alejos J, Galindo A, Boechat M, Laks H . Three-dimensional helical CT of pulmonary arteries in infants and children with congenital heart disease. AJR Am J Roentgenol. 1999; 173(1):109-15. DOI: 10.2214/ajr.173.1.10397109. View

14.

Shirali G . Three-dimensional echocardiography in congenital heart disease. Echocardiography. 2012; 29(2):242-8. DOI: 10.1111/j.1540-8175.2011.01612.x. View

15.

Prakash A, Powell A, Geva T . Multimodality noninvasive imaging for assessment of congenital heart disease. Circ Cardiovasc Imaging. 2010; 3(1):112-25. DOI: 10.1161/CIRCIMAGING.109.875021. View

16.

Greil G, Schoebinger M, Kuettner A, Schaefer J, Dammann F, Claussen C . Imaging of aortopulmonary collateral arteries with high-resolution multidetector CT. Pediatr Radiol. 2006; 36(6):502-9. DOI: 10.1007/s00247-006-0143-0. View

17.

Hernandez R, Bank E, Shaffer E, Snider A, Rosenthal A . Comparative evaluation of the pulmonary arteries in patients with right ventricular outflow tract obstructive lesions. AJR Am J Roentgenol. 1987; 148(6):1189-94. DOI: 10.2214/ajr.148.6.1189. View

18.

Leschka S, Oechslin E, Husmann L, Desbiolles L, Marincek B, Genoni M . Pre- and postoperative evaluation of congenital heart disease in children and adults with 64-section CT. Radiographics. 2007; 27(3):829-46. DOI: 10.1148/rg.273065713. View

19.

Dillman J, Hernandez R . Role of CT in the evaluation of congenital cardiovascular disease in children. AJR Am J Roentgenol. 2009; 192(5):1219-31. DOI: 10.2214/AJR.09.2382. View

20.

Hopkins K, Patrick L, Simoneaux S, Bank E, Parks W, Smith S . Pediatric great vessel anomalies: initial clinical experience with spiral CT angiography. Radiology. 1996; 200(3):811-5. DOI: 10.1148/radiology.200.3.8756937. View