Diagnostic accuracy of CT angiography in infants with tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries

Meinel, Felix G.; Huda, Walter; Schoepf, U. Joseph; Rao, Anil G.; Cho, Young Jun; Baker, G. Hamilton; Hlavacek, Anthony M.

doi:10.1016/j.jcct.2013.11.001

Cited by 51 publications

(21 citation statements)

References 14 publications

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“…The authors performed CTA in lieu of diagnostic catheterization and found that none required additional imaging after CTA. Similarly, a recent study on infants with Tetralogy of Fallot and major aorto-pulmonary collateral arteries found excellent accuracy of CTA in this setting and concluded that pre-surgical diagnostic catheterization may not be required in the majority of these patients [17].…”

Section: Discussionmentioning

confidence: 83%

ECG-Synchronized CT Angiography in 324 Consecutive Pediatric Patients: Spectrum of Indications and Trends in Radiation Dose

et al. 2014

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The aim of the study is to describe the spectrum of indications for pediatric ECG-synchronized CT angiography (CTA), the main determinants of radiation exposure, and trends in radiation dose over time at a single, tertiary referral center. The study was IRB approved and HIPAA compliant with informed consent waived. Between 2005 and 2013, 324 pediatric patients underwent ECG-synchronized CTA to evaluate known or suspected cardiovascular abnormalities (109 female, median age 8.1 years). The effective dose (ED) was calculated using age-specific correction factors. Univariate and multivariate regression analyses were performed to identify predictors of radiation dose. The most common primary indications for the CTA examinations included known or suspected coronary pathologies (n = 166), complex congenital heart disease (n = 73), and aortic pathologies (n = 41). Median radiation exposure decreased from 12 mSv for patients examined in the years 2005-2007 to 1.2 mSv for patients examined in the years 2011-2013 (p < 0.001). Patients scanned using a tube potential of 80 kV (n = 259) had a significantly lower median radiation dose (1.4 mSv) compared to patients who were scanned at 100 kV (n = 46, median 6.3 mSv) or 120 kV (n = 19, median 19 mSv, p < 0.001). Tube voltage, followed by tube current and the method of ECG-synchronization were the strongest independent predictors of radiation dose. Growing experience with dose-saving techniques and CTA protocols tailored to the pediatric population have led to a tenfold reduction in radiation dose over recent years and now allow routinely performing ECG-synchronized CTA in children with a radiation dose on the order of 1 mSv.

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Section: Discussionmentioning

confidence: 83%

ECG-Synchronized CT Angiography in 324 Consecutive Pediatric Patients: Spectrum of Indications and Trends in Radiation Dose

et al. 2014

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“…CTA plays a key role in the preoperative evaluation of this patient population. In particular, CTA provides data on the number of MAPCA, their diameter, origin, and course, and the supplied lung lobes [2]. A retrospective study of 18 cases performed by Meinel et al [2] found no statistically significant relationship between the median diameter measurements on CTA and catheterization.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, CTA provides data on the number of MAPCA, their diameter, origin, and course, and the supplied lung lobes [2]. A retrospective study of 18 cases performed by Meinel et al [2] found no statistically significant relationship between the median diameter measurements on CTA and catheterization. Transcatheter occlusion is currently the preferred method for the management of MAPCA [3].…”

Section: Discussionmentioning

confidence: 99%

Initial Research on Postoperative Management of Tetralogy of Fallot with Major Aortopulmonary Collaterals

Cheng

Fan²,

Tang³

et al. 2016

Cardiology

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Objectives: Tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCA) is a well-known but always severe congenital heart disease. This study was designed to explore proper management after radical correction of TOF with MAPCA based on a hierarchical approach. Methods: The following data were collected from 39 patients planned to undergo radical correction of TOF: age, weight, number of aortopulmonary collaterals, total lumen diameter and collateral diameter-to-body weight ratio, transcatheter occlusion and cardiac catheterization findings, mechanical ventilation time, and ICU monitoring time. The patients were divided into 4 groups by collateral diameter-to-body weight ratio as follows: <0.200 mm/kg (group 1), 0.200-0.500 mm/kg (group 2), >0.500 mm/kg (group 3), and no MAPCA (group 4). Data analysis was performed using IBM SPSS Statistics software for Mac version 22.0 (SPSS Inc., Chicago, Ill., USA) with logistic regression and Fisher's exact test. Results: Most of the patients recovered well after radical correction; postoperative complications occurred in 12 patients and included bloody sputum, low cardiac output syndrome, and severe pulmonary infection that led to tracheotomy. By prolonging the mechanical ventilation time of the patients with postoperative complications, the conditions in 3 patients were improved. However, in the remaining patients, the condition worsened until transcatheter occlusions were performed. Transcatheter occlusion was performed in all 7 patients in group 3 (100%). Only 2 of the 8 patients in group 2 required transcatheter occlusion (25%), and none of the 9 patients in group 1 required transcatheter occlusion (0%). Only 1 patient (group 3) died after radical correction. The transcatheter occlusion results showed a strong association with the total lumen diameter and the collateral diameter-to-body weight ratio (p < 0.05) but no obvious association with age, weight, or the number of aortopulmonary collaterals (p > 0.05). Conclusions: Postoperative management of patients with TOF and MAPCA has great significance. To reduce the morbidity and mortality, transcatheter coil embolization or surgical ligation should be performed in patients with a collateral diameter-to-body weight ratio of at least 0.500 mm/kg. In patients with values between approximately 0.200 and 0.500 mm/kg, prolongation of mechanical ventilation should have priority over transcatheter occlusion, and for patients with values below 0.200 mm/kg no additional treatment is needed.

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“…Multi-detector computed tomography (MDCT) is widely used for pre-and postoperative evaluation of thoracic and cardiovascular diseases in children [1][2][3][4][5]. The total number of examinations increased within the last years because of its wide availability, the short duration of the procedure and corresponding reduced need for sedation compared to MRI, and the availability of three-dimensional isovolumetric datasets [6,7].…”

Section: Introductionmentioning

confidence: 99%

Third-generation dual-source 70-kVp chest CT angiography with advanced iterative reconstruction in young children: image quality and radiation dose reduction

et al. 2016

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Diagnostic accuracy of CT angiography in infants with tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries

Cited by 51 publications

References 14 publications

ECG-Synchronized CT Angiography in 324 Consecutive Pediatric Patients: Spectrum of Indications and Trends in Radiation Dose

ECG-Synchronized CT Angiography in 324 Consecutive Pediatric Patients: Spectrum of Indications and Trends in Radiation Dose

Initial Research on Postoperative Management of Tetralogy of Fallot with Major Aortopulmonary Collaterals

Third-generation dual-source 70-kVp chest CT angiography with advanced iterative reconstruction in young children: image quality and radiation dose reduction

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