Hoffmann Andreas, Engelfriet Peter, Mulder Barbara
Department of Cardiology, University Hospital Basel, Lange Gasse 78, CH 4052 Basel, Switzerland.
Int J Cardiol. 2007 May 31;118(2):151-3. doi: 10.1016/j.ijcard.2006.07.012. Epub 2006 Sep 25.
Adult patients with congenital heart disease under follow-up often need to undergo diagnostic procedures which expose them to radiation.
To evaluate radiation doses in adult patients with congenital heart disease during follow-up.
Data on diagnostic procedures were used from the European Heart Survey on adult congenital heart disease, a multicenter retrospective cohort study. Lesions included in the survey were Atrial Septal Defect, Ventricular Septal Defect, Fallot, Fontan, Coarctation, Transposition of the Great Arteries, Marfan, and Cyanotic lesions. A total of 4110 patients (52% female) with a mean age of 32 years (range 17-85) were included. The follow-up time ranged from 0 to 72 months, with a median of 61 months. There were a total of 18,403 patient-years of follow-up. During this time, a mean of 4.5 visits per patient took place. Radiation doses were calculated using the number of examinations in each patient's data file. Effective radiation doses are given in millisievert (mSv).
The average cumulative annual effective dose per patient was 0.46 mSv. The relative contributions to these doses were 3% by chest X-rays, 39% by computed tomography scans, 42% by angiography, and 16% by nuclear scans. Effective doses were higher in patients with Fontan, Coarctation, Marfan and Cyanotic lesions, as well as in patients with Atrial Septal Defects.
Exposure to radiation during follow-up of patients with adult congenital heart disease mainly stems from computed tomography scans and angiography. Patients with Fontan, Coarctation, Marfan and Cyanotic lesions are more likely to get high doses from computed tomography. In these lesions, therefore, particular care should be taken to use non-ionizing imaging procedures whenever possible.
接受随访的成年先天性心脏病患者常常需要接受诊断性检查，这会使他们暴露于辐射之下。
评估成年先天性心脏病患者随访期间的辐射剂量。
采用欧洲成人先天性心脏病调查中的诊断性检查数据，这是一项多中心回顾性队列研究。该调查涵盖的病变包括房间隔缺损、室间隔缺损、法洛四联症、Fontan手术、主动脉缩窄、大动脉转位、马凡综合征以及青紫型病变。共纳入4110例患者（52%为女性），平均年龄32岁（范围17 - 85岁）。随访时间为0至72个月，中位数为61个月。总随访患者年数为18403人年。在此期间，每位患者平均就诊4.5次。根据每位患者数据文件中的检查次数计算辐射剂量。有效辐射剂量以毫希沃特（mSv）为单位给出。
每位患者的平均累积年有效剂量为0.46 mSv。这些剂量的相对贡献分别为：胸部X线检查占3%，计算机断层扫描占39%，血管造影占42%，核扫描占16%。Fontan手术、主动脉缩窄、马凡综合征和青紫型病变患者以及房间隔缺损患者的有效剂量更高。
成年先天性心脏病患者随访期间的辐射暴露主要源于计算机断层扫描和血管造影。Fontan手术、主动脉缩窄、马凡综合征和青紫型病变患者接受计算机断层扫描时更易接受高剂量辐射。因此，对于这些病变，应尽可能特别注意使用非电离成像检查方法。
