Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-25T19:02:36.429Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiovascular CT for evaluation of single-ventricle heart disease: risks and accuracy compared with interventional findings

Published online by Cambridge University Press:  11 September 2017

B. Kelly Han ,
Marnie Huntley ,
David Overman ,
Dawn Witt ,
David Dassenko ,
Ross F. Garberich  and
John R. Lesser
B. Kelly Han*
Affiliation:
Advanced Cardiac Imaging, Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, United States of America Division of Pediatric Cardiology and Cardiothoracic Surgery, The Children’s Heart Clinic, Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, United States of America
Marnie Huntley
Affiliation:
Division of Pediatric Cardiology and Cardiothoracic Surgery, The Children’s Heart Clinic, Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, United States of America
David Overman
Affiliation:
Division of Pediatric Cardiology and Cardiothoracic Surgery, The Children’s Heart Clinic, Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, United States of America
Dawn Witt
Affiliation:
Advanced Cardiac Imaging, Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, United States of America
David Dassenko
Affiliation:
Division of Pediatric Cardiology and Cardiothoracic Surgery, The Children’s Heart Clinic, Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, United States of America
Ross F. Garberich
Affiliation:
Advanced Cardiac Imaging, Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, United States of America
John R. Lesser
Affiliation:
Advanced Cardiac Imaging, Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, United States of America
*
Correspondence to: B. K. Han, MD, The Children’s Heart Clinic, 2530 Chicago Ave South, Suite 500, Minneapolis, MN 55404, United States of America. Tel: 612 813 8800; Fax: 612 813 8825; E-mail: khan@chc-pa.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

We sought to evaluate the risk and image quality from cardiovascular CT in patients across all stages of single-ventricle palliation, and to define accuracy by comparing findings with intervention and surgery.

Methods

Consecutive CT scans performed in patients with single-ventricle heart disease were retrospectively reviewed at a single institution. Diagnosis, sedation needs, estimated radiation dose, and adverse events were recorded. Anatomical findings, image quality (1–4, 1=optimal), and discrepancy compared with interventional findings were determined. Results are described as medians with their 25th and 75th percentiles.

Results

From January, 2010 to August, 2015, 132 CT scans were performed in single-ventricle patients of whom 20 were neonates, 52 were post-Norwood, 15 were post-Glenn, and 45 were post-Fontan. No sedation was used in 76 patients, 47 were under minimal or moderate sedation, and nine were under general anaesthesia. The median image quality score was 1.2. The procedural dose–length product was 24 mGy-cm, and unadjusted and adjusted radiation doses were 0.34 (0.2, 1.8) and 0.82 (0.55, 1.88) mSv, respectively. There was one adverse event. No major and two minor discrepancies were noted at the time of 79 surgical and 10 catheter-based interventions.

Conclusions

Cardiovascular CT can be performed with a low radiation exposure in patients with single-ventricle heart disease. Its accuracy compared with that of interventional findings is excellent. CT is an effective advanced imaging modality when a non-invasive pathway is desired, particularly if cardiac MRI poses a high risk or is contraindicated.

Keywords

Cardiac CTsingle-ventricle CHDrisk
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 1 , January 2018 , pp. 9 - 20
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Khairy, P, Fernandes, SM, Mayer, JE Jr, et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation 2008; 117: 85–92.Google Scholar
2. Khairy, P, Ionescu-Ittu, R, Mackie, AS, Abrahamowicz, M, Pilote, L, Marelli, AJ. Changing mortality in congenital heart disease. J Am Coll Cardiol 2010; 56: 1149–1157.Google Scholar
3. Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52: e143–e263.Google Scholar
4. Banka, P, McElhinney, DB, Bacha, EA, et al. What is the clinical utility of routine cardiac catheterization before a Fontan operation? PediatrCardiol 2010; 31: 977–985.Google ScholarPubMed
5. Stern, KW, McElhinney, DB, Gauvreau, K, Geva, T, Brown, DW. Echocardiographic evaluation before bidirectional Glenn operation in functional single-ventricle heart disease: comparison to catheter angiography. Circ Cardiovasc Imaging 2011; 4: 498–505.Google Scholar
6. 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
7. Cronin, EM, Mahon, N, Wilkoff, BL. MRI in patients with cardiac implantable electronic devices. Expert Rev Med Devices 2012; 9: 139–146.Google Scholar
8. Ramalho, J, Semelka, RC, Ramalho, M, Nunes, RH, AlObaidy, M, Castillo, M. Gadolinium-based contrast agent accumulation and toxicity: an update. AJNR Am J Neuroradiol 2016; 37: 1192–1198.Google Scholar
9. Kanda, T, Oba, H, Toyoda, K, Kitajima, K, Furui, S. Brain gadolinium deposition after administration of gadolinium-based contrast agents. Jpn J Radiol 2016; 34: 3–9.Google Scholar
10. Kanda, T, Matsuda, M, Oba, H, Toyoda, K, Furui, S. Gadolinium deposition after contrast-enhanced MR imaging. Radiology 2015; 277: 924–925.Google Scholar
11. Han, BK, Rigsby, CK, Hlavacek, A, et al. Computed tomography imaging in patients with congenital heart disease part I: rationale and utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT): Endorsed by the Society of Pediatric Radiology (SPR) and the North American Society of Cardiac Imaging (NASCI). J Cardiovasc Comput Tomogr 2015; 9: 475–492.Google Scholar
12. Halliburton, SS, Abbara, S, Chen, MY, et al. SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr 2011; 5: 198–224.Google Scholar
13. AAPM Task Group 23 of the Diagnostic Imaging Council CT Committee. The Measurement, Reporting, and Management of Radiation Dose in CT, AAPM report 96. College Park, MD: American Association of Physicists in Medicine; 2008.Google Scholar
14. AAPM Task Group 204. Size-Specific Dose Estimates (SSDE) in Pediatric and Adult Body CT Examinations, AAPM report no. 204; 2011.Google Scholar
15. Downing, TE, McDonnell, A, Zhu, X, et al. Cumulative medical radiation exposure throughout staged palliation of single ventricle congenital heart disease. Pediatr Cardiol 2015; 36: 190–195.CrossRefGoogle ScholarPubMed
16. Johnson, JN, Hornik, CP, Li, JS, et al. Cumulative radiation exposure and cancer risk estimation in children with heart disease. Circulation 2014; 130: 161–167.Google Scholar
17. Glatz, AC, Purrington, KS, Klinger, A, King, L, Huda, W, Hlavacek, AM. Cumulative exposure to medical radiation for children requiring surgery for congenital heart disease. J Pediatr 2014; 164: 789–794; e10.Google Scholar
18. Watson, TG, Mah, E, Schoepf, UJ, King, L, Huda, W, Hlavacek, AM. Effective radiation dose in computed tomographic angiography of the chest and diagnostic cardiac catheterization in pediatric patients. Pediatr Cardiol 2013; 34: 518–524.Google Scholar
19. Brown, DW, Gauvreau, K, Powell, AJ, et al. Cardiac magnetic resonance versus routine cardiac catheterization before bidirectional glenn anastomosis in infants with functional single ventricle: a prospective randomized trial. Circulation 2007; 116: 2718–2725.Google Scholar
20. Brown, DW, Gauvreau, K, Powell, AJ, et al. Cardiac magnetic resonance versus routine cardiac catheterization before bidirectional Glenn anastomosis: long-term follow-up of a prospective randomized trial. J Thorac Cardiovasc Surg 2013; 146: 1172–1178.Google Scholar
21. Han, BK, Vezmar, M, Lesser, JR, et al. Selective use of cardiac computed tomography angiography: an alternative diagnostic modality before second-stage single ventricle palliation. J Thorac Cardiovasc Surg 2014; 148: 1548–1554.Google Scholar
22. Fogel, MA. Is routine cardiac catheterization necessary in the management of patients with single ventricles across staged Fontan reconstruction? No!. Pediatr Cardiol 2005; 26: 154–158.Google Scholar
23. Fogel, MA, Pawlowski, TW, Whitehead, KK, et al. Cardiac magnetic resonance and the need for routine cardiac catheterization in single ventricle patients prior to Fontan: a comparison of 3 groups: pre-Fontan CMR versus cath evaluation. J Am Coll Cardiol 2012; 60: 1094–1102.Google Scholar
24. Prakash, A, Khan, MA, Hardy, R, Torres, AJ, Chen, JM, Gersony, WM. A new diagnostic algorithm for assessment of patients with single ventricle before a Fontan operation. J Thorac Cardiovasc Surg 2009; 138: 917–923.Google Scholar
25. Ramamoorthy, C, Haberkern, CM, Bhananker, SM, et al. Anesthesia-related cardiac arrest in children with heart disease: data from the Pediatric Perioperative Cardiac Arrest (POCA) registry. Anesth Analg 2010; 110: 1376–1382.Google Scholar
26. Girshin, M, Shapiro, V, Rhee, A, Ginsberg, S, Inchiosa, MA Jr. Increased risk of general anesthesia for high-risk patients undergoing magnetic resonance imaging. J Comput Assist Tomogr 2009; 33: 312–315.Google Scholar
27. Dorfman, AL, Odegard, KC, Powell, AJ, Laussen, PC, Geva, T. Risk factors for adverse events during cardiovascular magnetic resonance in congenital heart disease. J Cardiovasc Magn Reson 2007; 9: 793–798.Google Scholar
28. Rappaport, B, Mellon, RD, Simone, A, Woodcock, J. Defining safe use of anesthesia in children. N Eng J Med 2011; 364: 1387–1390.CrossRefGoogle ScholarPubMed
29. Hays, SR, Deshpande, JK. Newly postulated neurodevelopmental risks of pediatric anesthesia. Curr Neurol Neurosci Rep 2011; 11: 205–210.Google Scholar
30. Wilder, RT, Flick, RP, Sprung, J, et al. Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology. 2009; 110: 796–804.CrossRefGoogle Scholar
31. Flick, RP, Katusic, SK, Colligan, RC, et al. Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics. 2011; 128: e1053–e1061.Google Scholar
32. DiMaggio, C, Sun, LS, Kakavouli, A, Byrne, MW, Li, G. A retrospective cohort study of the association of anesthesia and hernia repair surgery with behavioral and developmental disorders in young children. J Neurosurg Anesthesiol 2009; 21: 286–291.Google Scholar
33. Fogel, MA, Weinberg, PM, Parave, E, et al. Deep sedation for cardiac magnetic resonance imaging: a comparison with cardiac anesthesia. J Pediatr 2008; 152: 534–539.e1.CrossRefGoogle ScholarPubMed
34. Odegard, KC, DiNardo, JA, Kussman, BD, et al. The frequency of anesthesia-related cardiac arrests in patients with congenital heart disease undergoing cardiac surgery. Anesth Analg 2007; 105: 335–343.Google Scholar
35. Miller, JH, Hu, HH, Pokorney, A, Cornejo, P, Towbin, R. MRI brain signal intensity changes of a child during the course of 35 gadolinium contrast examinations. Pediatrics 2015; 136: e1637–e1640.Google Scholar
36. Kanda, T, Oba, H, Toyoda, K, Furui, S. Recent advances in understanding gadolinium retention in the brain. AJNR Am J Neuroradiol 2016; 37: E1–E2.Google Scholar
37. Roberts, DR, Holden, KR. Progressive increase of T1 signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in the pediatric brain exposed to multiple doses of gadolinium contrast. Brain Dev 2016; 38: 331–336.Google Scholar
38. Kanda, T, Fukusato, T, Matsuda, M, et al. Gadolinium-based contrast agent accumulates in the brain even in subjects without severe renal dysfunction: evaluation of autopsy brain specimens with inductively coupled plasma mass spectroscopy. Radiology 2015; 276: 228–232.Google Scholar
39. Han, BK, Lesser, JR. CT imaging in congenital heart disease: an approach to imaging and interpreting complex lesions after surgical intervention for tetralogy of Fallot, transposition of the great arteries, and single ventricle heart disease. J Cardiovasc Comput Tomogr 2013; 7: 338–353.Google Scholar
40. Khairy, P, Van Hare, GF, Balaji, S, et al. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease. Heart Rhythm 2014; 11.Google Scholar
41. Guo, YK, Gao, HL, Zhang, XC, Wang, QL, Yang, ZG, Ma, ES. Accuracy and reproducibility of assessing right ventricular function with 64-section multi-detector row CT: comparison with magnetic resonance imaging. Int J Cardiol 2010; 139: 254–262.Google Scholar
42. van der Vleuten, PA, de Jonge, GJ, Lubbers, DD, et al. Evaluation of global left ventricular function assessment by dual-source computed tomography compared with MRI. Eur Radiol 2009; 19: 271–277.Google Scholar
43. Groen, JM, van der Vleuten, PA, Greuter, MJ, Zijlstra, F, Oudkerk, M. Comparison of MRI, 64-slice MDCT and DSCT in assessing functional cardiac parameters of a moving heart phantom. Eur Radiol 2009; 19: 577–583.Google Scholar
44. Plumhans, C, Muhlenbruch, G, Rapaee, A, et al. Assessment of global right ventricular function on 64-MDCT compared with MRI. Am J Roentgenol 2008; 190: 1358–1361.Google Scholar
Supplementary material: File

Han et al. supplementary material

Han et al. supplementary material 1

Download Han et al. supplementary material(File)
File 10.2 MB
Supplementary material: File

Han et al. supplementary material

Han et al. supplementary material 2

Download Han et al. supplementary material(File)
File 64.2 KB