MDCT evaluation of pulmonary embolism in children and young adults following a lateral tunnel Fontan procedure: optimizing contrast-enhancement techniques

Prabhu, Sanjay P.; Mahmood, Soran A.; Sena, Laureen; Lee, Edward Y.

doi:10.1007/s00247-009-1304-8

Cited by 51 publications

(29 citation statements)

References 29 publications

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“…Because there is no subpulmonary mixing chamber in the Fontan to homogenize contrast, CT pulmonary angiograms with a standard protocol have significant swirling artifact, heterogeneous contrast enhancement, and a high rate of false-positive results. 233 Nuclear lung perfusion scans are similarly unreliable because of asymmetric pulmonary blood flow patterns. Multidetector CT angiography with simultaneous upper and lower extremity contrast power injection with early-and late-phase image acquisition can improve diagnostic accuracy.…”

Section: Pathogenesismentioning

confidence: 99%

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

Lui¹,

Saïdi²,

Bhatt³

et al. 2017

Circulation

180

136

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ABSTRACT:Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.

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Section: Pathogenesismentioning

confidence: 99%

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

Lui¹,

Saïdi²,

Bhatt³

et al. 2017

Circulation

180

136

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“…Such flow anomalies have been reported to mimic pulmonary emboli in the setting of single cardiac ventricle, 9 Fontan procedure 10 and iatrogenic pulmonary vein stenosis post-cardiac radiofrequency ablation. 11 The complicated imaging appearance and concerning clinical findings of this episode took almost 18 months to be resolved, but concluded a course of missed diagnosis and incorrect management lasting many years.…”

Section: Accepted M Manuscriptmentioning

confidence: 98%

“…11 The complicated imaging appearance and concerning clinical findings of this episode took almost 18 months to be resolved, but concluded a course of missed diagnosis and incorrect management lasting many years. Asymmetric PA opacification has various unusual and potentially confusing causes (Table 1) 9,10,11,12,13,14,15,16 . The asymmetric PA flow artifact was repeatedly misinterpreted by many experienced radiologists and clinicians.…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

Baffle thrombosis in an adult with remote prior scimitar vein repair mimicking massive pulmonary embolism

Shulman¹,

Ayres²

2014

Clinical Imaging

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Please cite this article as: Shulman Ryan M., Yres Jonny A, Baffle thrombosis in an adult with remote prior Scimitar vein repair mimicking massive pulmonary embolism, Journal of Clinical Imaging (2014Imaging ( ), doi: 10.1016Imaging ( /j.clinimag.2014 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT DISCLOSURESThe authors report no conflicts of interest. KEY WORDS A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT

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“…In patients with impaired left ventricular function, for a fixed volume and flow rate of contrast, there is a delay in peak enhancement and lower attenuation than patients with normal left ventricular function (11). The cardiac output of patients with Fontan circuits is often impaired and consequently a test bolus or bolus tracking can help understand patient specific haemodynamics (see below).…”

Section: Patient Factors: Weight and Cardiac Outputmentioning

confidence: 99%

“…If a standard CT pulmonary angiographic protocol is performed in this patient group, it is almost certainly going to be either non-diagnostic or demonstrate a pseudoembolism or pseudothrombus (11). With an arm injection, contrast will usually flow preferentially into the RPA, very little in the left pulmonary artery and unopacified blood will be entering from below via the IVC or right atrial connection to the central pulmonary circulation (Figures 9,10).…”

Section: Pulmonary Embolism and Thrombus In The Fontan Circuitmentioning

confidence: 99%

Computed tomography in congenital heart disease: how generic principles can be applied to create bespoke protocols in the Fontan circuit

Loughborough

Yeong

Hamilton

et al. 2017

Quant. Imaging Med. Surg.

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Cardiac computed tomography (CCT) has become an invaluable cross-sectional imaging modality in congenital heart disease (CHD) patients. However, altered anatomical connections and cardiovascular physiology makes CHD arguably the most challenging area in CCT imaging, which remains a complimentary modality to cardiac magnetic resonance and echocardiography. A bespoke CT protocol is often required to achieve a diagnostic examination; this can be achieved through careful consideration of the basic principles of image acquisition and contrast administration. This article reviews these principles and demonstrates how they can be applied to CCT in CHD using the Fontan circulation as an example.

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MDCT evaluation of pulmonary embolism in children and young adults following a lateral tunnel Fontan procedure: optimizing contrast-enhancement techniques

Cited by 51 publications

References 29 publications

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

Baffle thrombosis in an adult with remote prior scimitar vein repair mimicking massive pulmonary embolism

Computed tomography in congenital heart disease: how generic principles can be applied to create bespoke protocols in the Fontan circuit

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