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Utility of computed tomographic angiography in the pre-operative planning for initial and repeat congenital cardiovascular surgery

Published online by Cambridge University Press:  29 March 2010

Alexander R. Ellis ,
Denise Mulvihill ,
Scott M. Bradley  and
Anthony M. Hlavacek
Alexander R. Ellis*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of the King’s Daughters, Eastern Virginia Medical School, Norfolk, Virginia, United States of America Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Denise Mulvihill
Affiliation:
Department of Radiology, Division of Pediatric Radiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Scott M. Bradley
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, United States of America
Anthony M. Hlavacek
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
*
Correspondence to: Dr A. R. Ellis, MD, MSc, Children’s Hospital of the King’s Daughters, Eastern Virginia Medical School, 601 Children’s Lane, Norfolk, Virginia 23507, United States of America. Tel: +1 757 668 7214; Fax: +1 757 668 8225; E-mail: [email protected]
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Abstract

Objective

To investigate the utility of computed tomographic angiography as an adjunctive imaging modality before congenital cardiac surgery.

Design

We evaluated 33 patients who underwent a pre-operative computed tomographic angiogram. They were classified according to the anatomic site of repair. Post-operatively, the surgeon completed a questionnaire assessing the utility of the study.

Results

Computed tomographic angiography was found to be either “essential” or “very useful” for pre-operative planning in 94% of the patients. Specifically, the scan was consistently useful for procedures involving the aorta (14/15, 93%) or the pulmonary veins (4/4, 100%) and obviated pre-operative catheterisations in 14 patients (42%). Furthermore, when compared with other diagnostic groups, computed tomographic angiography determined the need for peripheral cannulation in patients undergoing re-operations (6/7; 86%, p = 0.02).

Conclusions

Computed tomographic angiography was found to be useful in the pre-operative planning of virtually all patients undergoing repair of congenital cardiac malformations, regardless of diagnosis. Specifically, the studies were essential in select populations, such aortic arch or pulmonary vein repairs, and helped to determine cannulation sites for repeat operations while significantly reducing the need for invasive imaging.

Keywords

Congenital cardiac diseasealternative imaging modalityperioperative care
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 3 , June 2010 , pp. 262 - 268
Copyright
Copyright © Cambridge University Press 2010

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References

1. Ou, P, Celermajer, DS, Calcagni, G, Brunelle, F, Bonnet, D, Sidi, D. Three-dimensional CT scanning: a novel diagnostic modality in congenital heart disease. Heart 2007; 93: 908–913.CrossRefGoogle Scholar
2. Goo, HW, Park, IS, Ko, JK, Kim, YH, Seo, DM, Park, JJ. Computed tomography for the diagnosis of congenital heart disease in pediatric and adult patients. Int J Cardiovasc Imaging 2005; 21: 347–365; discussion 367.Google Scholar
3. Bean, MJ, Pannu, H, Fishman, EK. Three-dimensional computed tomographic imaging of complex congenital cardiovascular abnormalities. J Comput Assist Tomogr 2005; 29: 721–724.CrossRefGoogle ScholarPubMed
4. Cook, SC, Dyke, PC, Raman, SV. Management of adults with congenital heart disease with cardiovascular computed tomography. J Cardiovasc Comput Tomogr 2008; 2: 12–22.CrossRefGoogle ScholarPubMed
5. Jhang, WK, Park, J-J, Seo, D-M, Goo, HW, Gwak, M. Perioperative evaluation of airways in patients with arch obstruction and intracardiac defects. Ann Thorac Surg 2008; 85: 1753–1758.CrossRefGoogle ScholarPubMed
6. Spevak, PJ, Johnson, PT, Fishman, EK. Surgically corrected congenital heart disease: utility of 64-MDCT. Am J Roentgenol 2008; 191: 854–861.CrossRefGoogle ScholarPubMed
7. Leong, JL, Batra, PS, Citardi, MJ. Three-dimensional computed tomography angiography of the internal carotid artery for preoperative evaluation of sinonasal lesions and intraoperative surgical navigation. Laryngoscope 2005; 115: 1618–1623.CrossRefGoogle ScholarPubMed
8. Pechlivanis, I, Schmieder, K, Scholz, M, Konig, M, Heuser, L, Harders, A. 3-Dimensional computed tomographic angiography for use of surgery planning in patients with intracranial aneurysms. Acta Neurochir (Wien) 2005; 147: 1045–1053.Google Scholar
9. Herzog, C, Mulvihill, DM, Nguyen, SA, et al. Pediatric cardiovascular ct angiography: radiation dose reduction using automatic anatomic tube current modulation. Am J Roentgenol 2008; 190: 1232–1240.CrossRefGoogle ScholarPubMed
10. Taylor, A. Cardiac imaging: MR or CT? which to use when. Pediatr Radiol 2008; 38 (Suppl. 3): S433–S438.CrossRefGoogle ScholarPubMed
11. Ucar, T, Fitoz, E, Tutar, E, Atalay, S, Uysalel, A. Diagnostic tools in the preoperative evaluation of children with anomalous pulmonary venous connections. Int J Cardiovasc Imaging 2008; 24: 229–235.Google Scholar
12. Babu-Narayan, SV, Gatzoulis, MA, Kilner, PJ. Non-invasive imaging in adult congenital heart disease using cardiovascular magnetic resonance. J Cardiovasc Med (Hagerstown) 2007; 8: 23–29.Google Scholar
13. Kellenberger, CJ, Yoo, SJ, Buchel, ER. Cardiovascular MR imaging in neonates and infants with congenital heart disease. Radiographics 2007; 27: 5–18.Google Scholar
14. Fogel, MA. Cardiac magnetic resonance of single ventricles. J Cardiovasc Magn Reson 2006; 8: 661–670.CrossRefGoogle ScholarPubMed
15. Dorfman, AL, Geva, T. Magnetic resonance imaging evaluation of congenital heart disease: conotruncal anomalies. J Cardiovasc Magn Reson 2006; 8: 645–659.Google Scholar
16. Eichhorn, JG, Jourdan, C, Hill, SL, Raman, SV, Cheatham, JP, Long, FR. CT of pediatric vascular stents used to treat congenital heart disease. Am J Roentgenol 2008; 190: 1241–1246.CrossRefGoogle ScholarPubMed
17. Garg, R, Powell, AJ, Sena, L, Marshall, AC, Geva, T. Effects of metallic implants on magnetic resonance imaging evaluation of Fontan palliation. Am J Cardiol 2005; 95: 688–691.Google Scholar
18. Hlavacek, A, Mulvihill, D, Gonzalez, J, Shirali, G, Frey, D. Multidetector computed tomographic angiography results in lower radiation dose than diagnostic catheterization in pediatric patients. JACC 2008; 49: 264A.Google Scholar
19. DiSessa, TG, Di Sessa, P, Gregory, B, Vranicar, M. The use of 3D contrast-enhanced CT reconstructions to project images of vascular rings and coarctation of the aorta. Echocardiography 2009; 26: 76–81.Google Scholar