Three-Dimensional Rotational Angiography during Catheterization of Congenital Heart Disease – A ten Years’ experience at a single center

Abstract

this paper aims to assess the usability and advantages of three-dimensional rotational angiography (3DRA) in patients with congenital heart disease (CHD) and its application in the cath lab. Up to now, its use in CHD is not widespread or standardized. We analyzed all patients with CHD who underwent a 3DRA at our facility between January 2010 and May 2019. The 3DRAs were evaluated for radiation exposure, contrast dye consumption, diagnostic utility and image quality. We performed 872 3DRAs. 3DRA was used in 67.1% of the cases for interventional procedures and in 32.9% for diagnostic purposes. Two different acquisition programs were applied. The median dose-area product (DAP) for all 872 rotations was 54.1 µGym 2 (21.7-147.5 µGym 2) and 1.6 ml/kg (0.9-2.07 ml/kg) of contrast dye was used. Diagnostic utility of the generated 3D-model was rated superior to the native 3D angiography in 94% (819/872). 3DRA is an excellent and save diagnostic and interventional tool. However, 3DRA has not become a standard imaging procedure in pediatric cardiology up to now. Effort and advantage seems to be unbalanced, but new less invasive techniques may upgrade this method in future. Congenital heart disease (CHD) is often associated with complex anatomical anomalies. High-resolution imaging modalities are particularly helpful in this context 1. During the last decade, the three-dimensional rotational angiography (3DRA) has emerged as a new facility for diagnostic and interventional procedures. The 3DRA is performed by a C-arm of the angiography-system equipped with a flat detector. It generates a 3D volume data set from a single C-arm rotation (at least 180° plus fan angle) around the patient during a continuous injection of contrast dye. It provides a precise view of cardiovascular and surrounding structures in various projections 2 and can be used for 3D-guidance additionally 3,4. The 3DRA, also called flat detector computed tomography (FD-CT) or cone beam CT, was developed in the 1990s and initially used for neuroradiology procedures. In 1997, Fahrig et al. published the first experience with this technique in the setting of neuroendovascular therapy procedures 5. Furthermore, the benefit of this imaging tool was described for coil embolization of cerebral aneurysm, cardiac electrophysiology, valve replacement and liver tumor embolization 6-9. In 2010, Glatz et al. presented the first systematic analysis of 3DRA in the cardiac catheterization laboratory for patients with CHD 10. The 3DRA allows a real-time viewing of the native angiography (native 3DRA) as well as post processed precise 3D model (reconstructed 3DRA) for diagnostic purpose. Additionally, 3D navigation in catheter-based interventions is feasible. Nowadays, CT-like soft tissue image quality is acquirable due to continuous development of this technique 2. Until now, 3DRA has not become a standard procedure in the pediatric cardiac catheterization laboratory. This technique requires X-ray, a high volume contrast injection and is acquired intraprocedural with obstructio...

Multimodality 3D image fusion with live fluoroscopy reduces radiation dose during catheterization of congenital heart defects

“…Some studies show higher radiation exposure with 3DRA, yet more recent research suggests lower values when using optimized exposure settings for the 3DRA imaging protocol. Some authors argue that diagnostic 3DRA is outdated for primary diagnosis and 3D guidance due to the availability of MMIF 2D−3D ( 24 , 36 ). However, it remains valuable when preprocedural imaging is not possible ( 36 ).…”

“…Some authors argue that diagnostic 3DRA is outdated for primary diagnosis and 3D guidance due to the availability of MMIF 2D−3D ( 24 , 36 ). However, it remains valuable when preprocedural imaging is not possible ( 36 ).…”

Hemodynamic Consequence of Interventional Cardiac Catheterization in the Early Postoperative Period after Congenital Heart Surgery

“…Appreciation of concomitant lesions has improved with the application of three-dimensional imaging modalities such as angiographic computed tomography and traditional computed tomography, which can provide a definitive anatomical diagnosis of undiscovered lesions [12]. Recent studies have demonstrated growing trends in using three-dimensional rotational angiographies, which has been associated with superior outcomes in diagnostic and interventional procedures [13,14]. Hybrid procedures, initially intended for initial palliation of the hypoplastic left heart and complex single ventricle, have now been expanded to address septal defects and stenotic pulmonary arteries.…”