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The use of imaging that employs ionising radiation is increasing in the setting of paediatric cardiology. Children's high radiosensitivity and the lack of contemporary radiation data warrant a review of the radiation doses from the latest “state-of-the-art” angiography and computed tomography systems.
In children aged less than 16 years with congenital cardiac disease, we aimed to report: recent trends in the use of diagnostic angiography and cardiac dual-source computed tomography; the characteristics, lesions, and imaging histories of patients undergoing these procedures; and the average radiation doses imparted by each modality.
Retrospective review of consecutive cases undergoing cardiac computed tomography or diagnostic angiography in a teaching hospital between January, 2008 and December, 2009. Radiation doses were converted to effective doses (millisievert) using published conversion factors.
Angiography was performed 3.7 times more often than computed tomography. Computed tomography examinations increased by 92.5%, whereas angiography decreased by 26.4% in 2009 compared with 2008. Patients undergoing computed tomography were younger and weighed less than those undergoing angiography, but lesions were similar between the 2 groups. Multiple lifetime angiography was more prevalent than multiple lifetime computed tomography (p < 0.001). The median procedural dose – range – from angiography and computed tomography was 5 (0.2–27.8) and 1.7 (0.5–9.5) millisieverts, respectively (p < 0.001).
Despite not being completely analogous investigations, computed tomography should be considered prior to angiography and not withheld on radiation dose concerns, given that it imparts lower and more consistent doses than conventional angiography.
To evaluate the safety and efficacy of transcatheter occlusion of the arterial duct without femoral arterial catheterization.
Patent arterial ducts have been closed percutaneously since the 1960s. It remains standard practice to use arterial access for aortography before, during, and after implantation of the device. Femoral arterial catheterisation has well recognised complications, and should be avoided unless absolutely necessary.
We reviewed prospectively collected data relating to 389 occlusions of the arterial duct performed consecutively between 1994 and 2004. We inserted Cook detachable coils in 288 instances using the Amplatzer duct occluder in the remaining 101. Information was obtained regarding procedural success, displacement of the device, and re-intervention. We have followed out patients for a median of 1.15 years in those closed with the Amplatzer device, and 1.09 years in those closed with a coil.
In the patients in whom we used coils, occlusion was possible in 75% using venous access alone. We reintervened in 25 patients, because of embolisation of the device in 6, haemolysis in 5, and residual shunting in 14. On follow-up, complete occlusion had been achieved in 98%. We found trivial stenosis of the left pulmonary artery in 3 patients. When using the Amplatzer device, closure using venous access alone was achieved in 82%, and 2 patients required reintervention because of embolisation of the device. Complete occlusion had been achieved in all patients as judged by follow-up at 1 year, and 2 patients had trivial stenosis of the left pulmonary artery.
Arterial catheterisation is unnecessary in the great majority of patients undergoing occlusion of the arterial duct. Use of venous catheterisation alone is safe, and does not appear to increase the risk of device-related complications.
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