Repair of Congenital Heart Disease: A Primer–Part 1

Abstract

Advances in the surgical management of congenital heart disease have led to enhanced patient survival and quality of life. Improvements in technology in computed tomography and magnetic resonance imaging have resulted in increasing use of cross-sectional imaging in these patients. Perioperative care in these patients requires that radiologists have an understanding of the surgical treatment and the resultant postoperative anatomy. Because many of these patients with treated congenital heart disease are being followed into the 4th and 5th decades of life, this is information that will fall within the domain of the radiologist who deals with adults. This review, which is presented in two parts, covers the major surgical procedures used for the treatment of congenital heart disease, and will be presented in two parts. In part 1, median sternotomy and its complications, palliative procedures, and complex repairs are discussed.

Role of 256 slice CT scan in pre and postoperative evaluation of congenital cardio-vascular anomalies: our experience at a tertiary care teaching hospital

“…UCT enables accurate delineation of complex anatomy of cardiovascular system both before and after surgery especially in pediatric patients. 9,15 Cardiac CT angiography (CCTA) is the modality of choice for evaluation of postoperative complications and also to evaluate the status of conduits, shunts and stents.…”

“…In TOF due to pulmonary atresia or pulmonary stenosis, the blood supply to the lungs comes from the various collaterals arising from the aorta and/or other systemic arteries know as major aortopulmonary collateral arteries (MAPCAS). 15 This is easily diagnosed by CCTA as it can demonstrate the caliber and number of the mapcas. Hence, it is the modality of choice for the evaluation of mapcas before embolization or reimplantation.…”

“…Hence, it is the modality of choice for the evaluation of mapcas before embolization or reimplantation. 12,[15][16][17] CT is also very useful for pre and post-operative evaluation of PAPVR/TAPVR. 4,13,18 In this study, we had a case of Down syndrome (DS) with TOF in which augmentation of MPA was done; two years later developed severe stenosis of right pulmonary artery (RPA) and mild stenosis of left pulmonary artery (LPA) as shown in Figure 3.…”

“…17,22 It can also demonstrate the various complication like residual/re-coarctation or pseudo-coarctation formation and is also very useful in the evaluation of stent patency and various complications like stent migration or occlusion/stenosis. 15,23 In this study, we had two known cases of Marfan's syndrome associated with huge aneurysm of the aortic root and AA. Bentall surgery was done replacing the aortic root along with the valves with artificial conduit and the coronary arteries (CAs) were re-anastomosed to the conduit.…”

“…The disadvantages of CA over CCTA are higher catheter related complications, larger volume of contrast, longer duration of sedation and higher radiation dose. [6][7][8] Because of these limitations of echo and CA, CTCA and MRI are considered to be alternative, complementary as well as problem solving diagnostic tools for the evaluation of CCVA. 9 CMRI can accurately give anatomical and physiological information which cannot be provided by the echo and CA alone.…”