Skip to main content Accessibility help
×
Home

Assessment of cavopulmonary connections by advanced imaging: value of flat-detector computed tomography

  • Martin Glöckler (a1), Andreas Koch (a1), Julia Halbfaß (a1), Verena Greim (a1), Andrè Rüffer (a2), Robert Cesnjevar (a2), Stephan Achenbach (a3) and Sven Dittrich (a1)...

Abstract

Objectives

To investigate the impact of flat-detector computed tomography on the clinical assessment of patients with cavopulmonary connections, and to evaluate the obtained diagnostic accuracy and supplementary information, as well as the value of overlaid three-dimensional reconstructions on fluoroscopic images during catheter-based interventions.

Methods

We analysed 31 consecutive patients retrospectively in whom flat-detector computed tomography was used to visualise the cavopulmonary connection. We investigated patients with cavopulmonary connections either early post-operatively (first group), before converting to a total cavopulmonary connection (second group), and patients with failing total cavopulmonary connection (third group). Flat-detector computed tomography based on a single rotational angiography was used to create a three-dimensional vascular model. The clinical value of flat-detector computed tomography was evaluated using standard categories of diagnostic utility. Used contrast volume and radiation exposure were quantified.

Results

Within 18 months, flat-detector computed tomography was performed in 31 cases with cavopulmonary connections. The median age was 1.9 years (range 0.3–43 years). In the first group, we found anomalies in 4 out of 8 cases, which led to therapeutic or prophylactic procedures; in the second and third groups, we performed interventions in 14 out of 23 cases. The overall clinical value was always rated superior to conventional biplane angiography. The median dose area product was 91.8 microgray square metres (range 33.0–679.3 microgray square metres). The required contrast medium was 2.08 millilitres per kilogram (range 0.66–4.7 millilitres per kilogram).

Conclusion

Flat-detector computed tomography improves the diagnostic accuracy in cavopulmonary connections and provides additional diagnostic information, which may lead to therapeutic or prophylactic procedures. Overlaid three-dimensional images on fluoroscopy facilitate and provide security for interventions.

Copyright

Corresponding author

Correspondence to: Dr M. Glöckler, MD, Department of Pediatric Cardiology, University Hospital Erlangen, Loschgestrasse 15, D-91054 Erlangen, Germany. Tel: +49 9131 8533750; Fax: +49 9131 8535987; E-mail: martin.gloeckler@uk-erlangen.de

References

Hide All
1. Girod, DA, Fontan, F, Deville, C, Ottenkamp, J, Choussat, A. Long-term results after the Fontan operation for tricuspid atresia. Circulation 1987; 75: 605610.
2. Nakata, S, Imai, Y, Takanashi, Y, et al. 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: 610619.
3. Senzaki, H, Isoda, T, Ishizawa, A, Hishi, T. Reconsideration of criteria for the Fontan operation. Influence of pulmonary artery size on postoperative hemodynamics of the Fontan operation. Circulation 1994; 89: 11961202.
4. Harris, MA, Cosulich, MT, Gillespie, MJ, et al. Pre-Fontan cardiac magnetic resonance predicts post-Fontan length of stay and avoids ionizing radiation. J Thorac Cardiovasc Surg 2009; 138: 941947.
5. Brown, DW, Gauvreau, K, Moran, AM, et al. Clinical outcomes and utility of cardiac catheterization prior to superior cavopulmonary anastomosis. J Thorac Cardiovasc Surg 2003; 126: 272281.
6. Holzer, RJ, Sisk, M, Chisolm, JL, et al. Completion angiography after cardiac surgery for congenital heart disease: complementing the intraoperative imaging modalities. Pediatr Cardiol 2009; 30: 10751082.
7. Ba, HO, Marini, D, Kammache, I, et al. Preoperative evaluation of candidates for total cavopulmonary connection: the role of echocardiography and cardiac catheterization. Arch Cardiovasc Dis 2009; 102: 303309.
8. Ro, PS, Rychik, J, Cohen, MS, Mahle, WT, Rome, JJ. Diagnostic assessment before Fontan operation in patients with bidirectional cavopulmonary anastomosis: are noninvasive methods sufficient? J Am Coll Cardiol 2004; 44: 184187.
9. 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 2010; 3: 11491157.
10. Glockler, M, Koch, A, Greim, V, et al. The value of flat-detector computed tomography during catheterisation of congenital heart disease. Eur Radiol 2011; 21: 25112520.
11. Gupta, R, Cheung, AC, Bartling, SH, et al. Flat-panel volume CT: fundamental principles, technology, and applications. Radiographics 2008; 28: 20092022.
12. Kalender, WA, Kyriakou, Y. Flat-detector computed tomography (FD-CT). Eur Radiol 2007; 17: 27672779.
13. Ellis, AR, Mulvihill, D, Bradley, SM, Hlavacek, AM. Utility of computed tomographic angiography in the pre-operative planning for initial and repeat congenital cardiovascular surgery. Cardiol Young 2010; 20: 262268.
14. Wielandts, JY, Smans, K, Ector, J, De Buck, S, Heidbuchel, H, Bosmans, H. Effective dose analysis of three-dimensional rotational angiography during catheter ablation procedures. Phys Med Biol 2010; 55: 563579.
15. Feldt, RH, Driscoll, DJ, Offord, KP, et al. Protein-losing enteropathy after the Fontan operation. J Thorac Cardiovasc Surg 1996; 112: 672680.
16. Glockler, M, Severin, T, Arnold, R, et al. First description of three patients with multifocal lymphangiomatosis and protein-losing enteropathy following palliation of complex congenital heart disease with total cavo-pulmonary connection. Pediatr Cardiol 2008; 29: 771774.
17. Rychik, J. Management of protein-losing enteropathy after the Fontan procedure. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1998; 1: 1522.
18. Fraisse, A, Colan, SD, Jonas, RA, Gauvreau, K, Geva, T. Accuracy of echocardiography for detection of aortic arch obstruction after stage I Norwood procedure. Am Heart J 1998; 135: 230236.
19. McMahon, CJ, Eidem, BW, Bezold, LI, et al. Is cardiac catheterization a prerequisite in all patients undergoing bidirectional cavopulmonary anastomosis? J Am Soc Echocardiogr 2003; 16: 10681072.
20. Achenbach, S, Marwan, M, Ropers, D, et al. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J 2010; 31: 340346.
21. Lell, M, Hinkmann, F, Anders, K, et al. High-pitch electrocardiogram-triggered computed tomography of the chest: initial results. Invest Radiol 2009; 44: 728733.
22. Lell, MM, May, M, Deak, P, et al. High-pitch spiral computed tomography: effect on image quality and radiation dose in pediatric chest computed tomography. Invest Radiol 2011; 46: 116123.
23. Shope, TB, Gagne, RM, Johnson, GC. A method for describing the doses delivered by transmission X-ray computed tomography. Med Phys 1981; 8: 488495.
24. Fahrig, R, Dixon, R, Payne, T, Morin, RL, Ganguly, A, Strobel, N. Dose and image quality for a cone-beam C-arm CT system. Med Phys 2006; 33: 45414550.
25. Kyriakou, Y, Deak, P, Langner, O, Kalender, WA. Concepts for dose determination in flat-detector CT. Phys Med Biol 2008; 53: 35513566.

Keywords

Assessment of cavopulmonary connections by advanced imaging: value of flat-detector computed tomography

  • Martin Glöckler (a1), Andreas Koch (a1), Julia Halbfaß (a1), Verena Greim (a1), Andrè Rüffer (a2), Robert Cesnjevar (a2), Stephan Achenbach (a3) and Sven Dittrich (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed