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

Published online by Cambridge University Press:  08 March 2012

Martin Glöckler ,
Andreas Koch ,
Julia Halbfaß ,
Verena Greim ,
Andrè Rüffer ,
Robert Cesnjevar ,
Stephan Achenbach  and
Sven Dittrich
Martin Glöckler*
Affiliation:
Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
Andreas Koch
Affiliation:
Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
Julia Halbfaß
Affiliation:
Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
Verena Greim
Affiliation:
Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
Andrè Rüffer
Affiliation:
Department of Congenital Heart Surgery, University Hospital Erlangen, Erlangen, Germany
Robert Cesnjevar
Affiliation:
Department of Congenital Heart Surgery, University Hospital Erlangen, Erlangen, Germany
Stephan Achenbach
Affiliation:
Department of Cardiology, University Hospital Erlangen, Erlangen, Germany
Sven Dittrich
Affiliation:
Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
*
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: [email protected]
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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.

Keywords

Three-dimensionalrotational angiographyinterventions in congenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 23 , Issue 1 , February 2013 , pp. 18 - 26
Copyright
Copyright © Cambridge University Press 2012

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