Kawano T, Ishii M, Takagi J, Maeno Y, Eto G, Sugahara Y, Toshima T, Yasunaga H, Kawara T, Todo K, Kato H
Department of Pediatrics and the Cardiovascular Research Institute, Kurume University School of Medicine, Japan.
Am Heart J. 2000 Apr;139(4):654-60.
For the clinical management of patients with complex congenital heart disease (CHD), accurate evaluation of their morphologic conditions is critical. Three-dimensional (3D) helical computed tomography (CT) angiography has been used to assess the vascular system in adult patients; the indication for complex CHD, especially in the neonatal period, has not yet been defined. Therefore the purposes of our study were to determine the quality and limitations of current 3D helical CT angiography for neonates and infants with complex CHD and to assess the clinical utility of this technique.
3D helical CT angiography was performed in 17 patients with various types of complex CHD. Their median age was 41 days (range 3 days to 9 months), and mean body weight was 3.6 kg (range 2.2 to 8.5 kg). All 3D images were produced with the 3D reconstruction algorithm of shaded-surface display. Oral sedation was required in only 4 infants during the procedure. 3D helical CT angiography clearly demonstrated the shape and spatial relation of great arteries, proximal branch pulmonary arteries, anomalous pulmonary venous connections, the patent ductus arteriosus, and a shunt. The 3D information of extracardiac morphologic characteristics and 3D anatomic relation of each extracardiac structure were easily recognized by this imaging process. However, intracardiac structure could not be visualized because of blurred and/or unclear edges of the ventricular wall caused by respiratory movement.
3D helical CT angiography represents an important additional diagnostic tool and may become an alternative method to angiography or other noninvasive techniques used in the evaluation of extracardiac anomalies in neonates and infants with complex CHD.
对于复杂先天性心脏病（CHD）患者的临床管理，准确评估其形态状况至关重要。三维（3D）螺旋计算机断层扫描（CT）血管造影已用于评估成年患者的血管系统；复杂CHD的适应症，尤其是在新生儿期，尚未明确。因此，我们研究的目的是确定当前3D螺旋CT血管造影对患有复杂CHD的新生儿和婴儿的质量和局限性，并评估该技术的临床实用性。
对17例各种类型复杂CHD患者进行了3D螺旋CT血管造影。他们的中位年龄为41天（范围3天至9个月），平均体重为3.6 kg（范围2.2至8.5 kg）。所有3D图像均采用表面阴影显示的3D重建算法生成。在检查过程中仅4例婴儿需要口服镇静剂。3D螺旋CT血管造影清楚地显示了大动脉的形态和空间关系、近端分支肺动脉、肺静脉异常连接、动脉导管未闭和分流。通过该成像过程可以轻松识别心外形态特征的3D信息和每个心外结构的3D解剖关系。然而，由于呼吸运动导致心室壁边缘模糊和/或不清楚，心内结构无法可视化。
3D螺旋CT血管造影是一种重要的辅助诊断工具，可能成为用于评估患有复杂CHD的新生儿和婴儿心外异常的血管造影或其他非侵入性技术的替代方法。
