Utility of computed tomographic angiography in the pre-operative planning for initial and repeat congenital cardiovascular surgery

Ellis, Alexander R.; Mulvihill, Denise; Bradley, Scott M.; Hlavacek, Anthony M.

doi:10.1017/s1047951109990904

Cited by 15 publications

(12 citation statements)

References 19 publications

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“…In 2010, Ellis et al reported their experience with preoperative CT scans in 33 patients, using a Siemens 64 slice MDCT scanner. They assessed the utility of CT scans and rated them important in procedures involving the aorta and underlined the impact of CT in almost all patients undergoing surgery of CHD [9]. In the study of Cheng et al (2009), ECG-triggered DSCT was performed prospectively in 55 patients.…”

Section: Discussionmentioning

confidence: 99%

“…All these VRT models as well as conventional 2D multiplanar reconstruction were presented to the cardiac surgeons during preoperative interdisciplinary conferences. The cardiac surgeons rated the value of the 3D image retrospectively, using a previously published 5-point Likert scale [8,9]: If the surgery could not have been performed appropriately without the information provided by the 3D model, the case was rated 'essential'. When it was felt to add important information to what had already been available, the case was rated 'very useful'.…”

Section: Methodsmentioning

confidence: 99%

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Preoperative assessment of the aortic arch in children younger than 1 year with congenital heart disease: utility of low-dose high-pitch dual-source computed tomography. A single-centre, retrospective analysis of 62 cases

Glöckler

Halbfass

Koch

et al. 2013

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES: To evaluate the feasibility, image quality and impact of 3D imaging in low-dose high-pitch dual-source computed tomography (DSCT) to assess arbitrary anatomical malformations of the aortic arch in children <1 year of age with congenital heart disease (CHD). METHODS:Between January 2010 and May 2013, DSCT was performed to assess the aortic arch anatomy in a total of 62 consecutive patients with CHD (aged 0-348 days). DSCT was used whenever conventional echocardiography was not sufficient to display the complex anatomy entirely. Image data acquisition was realized within a single cardiac cycle using prospective ECG triggering. 3D reconstruction for surgical planning was performed. Image quality was assessed retrospectively, using a 4-point scale from '1 = no artefacts' to '4 = uninterpretable'. The accuracy and impact of the 3D reconstructions was compared with intraoperative findings using a 5-point scale (from '1 = essential' to '5 = misleading'). Administered radiation exposure was evaluated. RESULTS:Imaging was successful in all patients, image quality was rated 1.34 on the 4-point scale and the impact of the 3D reconstructions for surgical planning was 2.05 on the 5-point scale. Mean dose-length product was 6.8 ± 2.6 mGy cm, and the effective dose was 0.45 ± 0.13 mSv (0.21-0.74).CONCLUSIONS: DSCT is a fast and appropriate imaging modality in the preoperative assessment of the aortic arch for surgical planning in CHD.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Preoperative assessment of the aortic arch in children younger than 1 year with congenital heart disease: utility of low-dose high-pitch dual-source computed tomography. A single-centre, retrospective analysis of 62 cases

Glöckler

Halbfass

Koch

et al. 2013

European Journal of Cardio-Thoracic Surgery

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“…Die so erstellte 3D-Überlagerung wurde separat zur 3D-Navigation neben dem herkömmlichen Fluoroskopiebild im Katheterlabor angezeigt. Jede FD-CT-Untersuchung wurde hinsichtlich Nutzen und Qualität einvernehmlich von 2 erfahrenen Kinderkardiologen mithilfe einer standardisierten, im Vorfeld publizierten, 5-Punkte-LikertSkala bewertet [12,13] Nutzen der FD-CT wie folgt beurteilt: In 96,6 % der Fälle wurden die FD-CTs als hilfreich bewertet und hatten eine diagnostische Aussagekraft, welche jene einer biplanen konventionellen Angiografie übertrifft ("essenziell", "sehr nützlich", "nützlich"). war es wichtig, dass das VOI während der gesamten Akquisitionszeit gleichmäßig kontrastiert war.…”

Section: Purposeunclassified

Flachdetektor-Computertomografie in der diagnostischen und interventionellen Kinderkardiologie

Moesler

Dittrich

Rompel

et al. 2013

Fortschr Röntgenstr

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Zusammenfassung Ziel: Evaluation der Einsatzm?glichkeiten der Flachdetektor-Computertomografie (FD-CT) bei der Katheterisierung von Patienten mit angeborenen Herzfehlern. Erstellen von Anwendungsprotokollen f?r unterschiedliche Fragestellungen anhand der erzielten Bildqualit?t in verschiedenen anatomischen Regionen. Material und Methoden: Die FD-CT wurde zwischen Januar 2010 und April 2012 in 176 F?llen w?hrend der Herzkatheteruntersuchung verwendet. Zur Evaluation der Bildqualit?t wurde eine 5-Punkte-Likert-Skala (von ?essenziell? bis ?irref?hrend?) verwendet. Alle F?lle wurden retrospektiv analysiert und es wurden Applikationsprotokolle zur Visualisierung der Aorta, Pulmonalarterien, Lungenvenen, Semilunarklappen, cavopulmonalen Anastomosen und systemven?ser Tunnel erstellt. Der Kontrastmittelverbrauch und die Strahlendosis wurden ausgewertet. Ergebnisse: Im untersuchten Zeitraum wurde die FD-CT in 176 F?lle durchgef?hrt. Die Patienten hatten ein mittleres Alter von 7,0 Jahren (0,01???42,53 Jahre). Die klinische Wertigkeit der FD-CT ?bertraf in 96,6?% der F?lle die konventionelle Angiografie und wurde nie als ?irref?hrend? bewertet. Die FD-CT wurde in 3,4?% der F?lle als ?essenziell?, in 77,3?% der F?lle als ?sehr n?tzlich?, in 15,9?% der F?lle als ?n?tzlich? und in 3,4?% der F?lle als ?nicht n?tzlich? bewertet. Das?mittlere Dosis-Fl?chen-Produkt war 99??Gym2 (19,3???1276,6??Gym2). Die ben?tigte Kontrastmittelmenge 1,76?ml/kg (0,9???5?ml/kg). Applikationsprotokolle zur Visualisierung unterschiedlicher anatomischer Regionen werden dargestellt. Schlussfolgerung: Die FD-CT ist ein neues und hilfreiches Verfahren bei der diagnostischen und interventionellen Katheterisierung von Patienten mit angeborenen Herzfehlen. Insbesondere extrakardiale vaskul?re Strukturen lassen sich in hoher Aufl?sung dreidimensional darstellen und dienen zur Diagnostik, chirurgischen Planung und zur 3D-Navigation bei Interventionen.

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“…During the surgical planning conference, the 3D-image data was presented by a pediatric cardiologist to the cardiac surgery team directly on the TeraRecon workstation to precisely clarify the specific anatomical situation, and specific questions posed were answered immediately using appropriate visualization. The benefits resulting for the surgical intervention planning were evaluated by the surgeon using a 5-point Likert scale following surgery [19]. Datasets were rated as "essential" if the surgeries as performed would not have been possible without the information obtained from DSCT.…”

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confidence: 99%

Application of Dual-Source-Computed Tomography in Pediatric Cardiology in Children Within the First Year of Life

Hausmann

Stenger

Dittrich

et al. 2016

Fortschr Röntgenstr

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!Purpose: To assess fields of application and value of dual source computed tomography (DSCT) for diagnostics and therapy in patients with congenital heart disease during their first year of life. Evaluation of image quality, surgical use and radiation exposure of 2nd and 3 rd generation DSCT. Materials and methods: DSCT was applied in 118 cases between January 2012 and October 2014 for diagnostics of congenital heart defects. 2nd generation was used in 91 cases until April 2014 and 3 rd generation in 27 cases during the period thereafter. 3 D reconstructions of the image data were created for clinical diagnostics and planning of interventions. Image quality was assessed using a 4-pointscale. The visibility of the mammary arteries was analyzed, and signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR) were calculated. The usefulness of 3D-reconstructions for surgical planning was rated using a 5-pointscale. Radiation exposure and contrast dye consumption were determined. All cases were analyzed retrospectively. Results: DSCT was successfully used in 118 cases. All image data obtained were interpretable. More than 60 percent of cases did not show any artifacts. The mammary arteries were visible down to the diaphragmatic arch in more than 80 percent of cases. Diagnostic value and surgical benefit were evaluated as "useful" or as "essential" in all cases. Median radiation dose was 0.4 mSv and 0.27 mSv for the 2nd and 3 rd generation DSCT, respectively. Consumption of contrast dye was 2 ml/kg in all cases. Conclusion: DSCT is a modern and extremely helpful technique for diagnostics and planning of interventions in patients with complex congenital heart defects. Extracardiac vascular structures in particular can be depicted threedimensionally at high resolution. The use of iterative reconstruction with 3 rd generation DSCT yielded image quality similar to that of 2nd generation DSCT at considerably reduced radiation exposure level compared to 2nd generation DSCT. 3 rd generation DSCT is a low risk, accurate and extremely fast technique for diagnosing unstable patients with CHD.

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Utility of computed tomographic angiography in the pre-operative planning for initial and repeat congenital cardiovascular surgery

Cited by 15 publications

References 19 publications

Preoperative assessment of the aortic arch in children younger than 1 year with congenital heart disease: utility of low-dose high-pitch dual-source computed tomography. A single-centre, retrospective analysis of 62 cases

Preoperative assessment of the aortic arch in children younger than 1 year with congenital heart disease: utility of low-dose high-pitch dual-source computed tomography. A single-centre, retrospective analysis of 62 cases

Flachdetektor-Computertomografie in der diagnostischen und interventionellen Kinderkardiologie

Application of Dual-Source-Computed Tomography in Pediatric Cardiology in Children Within the First Year of Life

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