Garg Naveen, Walia Rohit, Neyaz Zafar, Kumar Sunil
Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Asian Cardiovasc Thorac Ann. 2015 Feb;23(2):164-75. doi: 10.1177/0218492314538844. Epub 2014 Jun 9.
To compare multidetector computed tomographic angiography with the gold standard cardiac catheterization and angiography in tetralogy of Fallot.
In 40 consecutive patients over 5 years of age with tetralogy of Fallot, multidetector computed tomographic angiography and catheterization angiography studies were compared for intracardiac anatomy, pulmonary anatomy and indices, coronaries and collaterals. Safety parameters, relative advantages and limitations were also analyzed.
All catheterization studies required hospitalization whereas all tomographic studies were performed as outpatient procedures. The need for sedation and amount of contrast used were significantly greater in catheterization than in tomographic studies. Complications noted during catheterization were access site complications in 4 patients, cyanotic spells in 2, transient complete heart block requiring temporary pacing in 2, and air embolism in one. No complication was observed during tomographic studies. All tomographic studies were adequate, but 2 catheterization studies were inadequate. Ventricular septal defects, aortic override, level of right ventricular outflow tract obstruction, and pulmonary artery anatomy were equally assessed by both imaging modalities. However, tomographic studies missed additional small muscular ventricular septal defects. There was a linear correlation between tomographic and catheterization studies for pulmonary annulus size, artery sizes, Z-score, and Nakata index. There was complete concordance with respect to side of aortic arch and detection of collaterals. Coronary anatomy was better delineated in tomographic studies.
For preoperative evaluation of tetralogy of Fallot patients, multidetector computed tomographic angiography can be used as a reliable noninvasive alternative to cardiac catheterization angiography.
在法洛四联症患者中，比较多排螺旋计算机断层血管造影术与金标准心脏导管插入术及血管造影术。
对40例年龄超过5岁的法洛四联症连续患者，比较多排螺旋计算机断层血管造影术和导管插入血管造影术在心脏内解剖结构、肺解剖结构及指标、冠状动脉和侧支血管方面的情况。还分析了安全参数、相对优势和局限性。
所有导管插入术研究均需住院，而所有断层扫描研究均作为门诊手术进行。导管插入术所需的镇静剂用量和造影剂用量明显多于断层扫描研究。导管插入术期间记录的并发症包括4例穿刺部位并发症、2例发绀发作、2例需临时起搏的短暂完全性心脏传导阻滞和1例空气栓塞。断层扫描研究期间未观察到并发症。所有断层扫描研究均充分，但2例导管插入术研究不充分。两种成像方式对室间隔缺损、主动脉骑跨、右心室流出道梗阻水平和肺动脉解剖结构的评估相同。然而，断层扫描研究遗漏了额外的小肌部室间隔缺损。断层扫描研究与导管插入术研究在肺动脉环大小、动脉大小、Z评分和中田指数方面存在线性相关性。在主动脉弓侧和侧支血管检测方面完全一致。断层扫描研究对冠状动脉解剖结构的描绘更好。
对于法洛四联症患者的术前评估，多排螺旋计算机断层血管造影术可作为心脏导管插入血管造影术可靠的非侵入性替代方法。
