Han B Kelly, Vezmar Marko, Lesser John R, Michalak Gregory, Grant Katharine, Dassenko David, Maresh Jill, Overman David M
Advanced Cardiac Imaging, Minneapolis Heart Institute and Foundation, Minneapolis, Minn; Division of Cardiology and Cardiothoracic Surgery, Children's Heart Clinic, Minneapolis, Minn; Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn.
Division of Cardiology and Cardiothoracic Surgery, Children's Heart Clinic, Minneapolis, Minn.
J Thorac Cardiovasc Surg. 2014 Oct;148(4):1548-54. doi: 10.1016/j.jtcvs.2014.04.047. Epub 2014 May 5.
To assess the accuracy and risk of substituting cardiac computed tomography for cardiac catheterization in select patients for evaluation of anatomy before second-stage single ventricle palliation.
This is a retrospective review of consecutive diagnostic cardiac catheterization (n=16) and computed tomography studies (n=16) performed before second-stage single ventricle palliation from March 2010 to July 2012 at a single institution. Risk (anesthesia, vascular access, contrast, and radiation exposure), accuracy, and postoperative course were compared. Nonparametric analysis was used to compare differences in group medians.
General anesthesia was used for 16 of 16 cardiac catheterization studies and 1 of 16 computed tomography studies. Vascular access was central venous and/or arterial for all cardiac catheterization studies and a peripheral intravenous line for all computed tomography studies. Median age- and size-adjusted radiation dose was 14.0 mSv for cardiac catheterization and 1.1 mSv for computed tomography. Contrast dose was 4.8 mL/kg for the cardiac catheterization group and 2 mL/kg for the computed tomography group. There were no computed tomography discrepancies and 1 discrepancy between cardiac catheterization and surgical findings. There were 8 adverse events in 6 patients in the cardiac catheterization group and 1 adverse event in the computed tomography group. There was no difference between groups in postoperative course or need for repeat intervention.
Cardiac computed tomography and cardiac catheterization are equally accurate for evaluation of anatomy before second-stage single ventricle palliation when compared with surgical findings. Computed tomography may be the preferred test in select patients because of decreased vascular access and anesthesia risk, lower radiation and contrast exposure, and fewer adverse events.
评估在部分患者中，用心脏计算机断层扫描替代心脏导管插入术以在二期单心室姑息治疗前评估解剖结构的准确性和风险。
这是一项对2010年3月至2012年7月在单一机构进行的二期单心室姑息治疗前连续的诊断性心脏导管插入术（n = 16）和计算机断层扫描研究（n = 16）的回顾性分析。比较了风险（麻醉、血管通路、造影剂和辐射暴露）、准确性和术后病程。采用非参数分析比较组中位数差异。
16项心脏导管插入术研究中有16项使用了全身麻醉，16项计算机断层扫描研究中有1项使用了全身麻醉。所有心脏导管插入术研究的血管通路均为中心静脉和/或动脉，所有计算机断层扫描研究的血管通路均为外周静脉通路。心脏导管插入术的年龄和体型调整后辐射剂量中位数为14.0 mSv，计算机断层扫描为1.1 mSv。心脏导管插入术组的造影剂剂量为4.8 mL/kg，计算机断层扫描组为2 mL/kg。计算机断层扫描未出现差异，心脏导管插入术与手术结果之间有1处差异。心脏导管插入术组6例患者出现8例不良事件，计算机断层扫描组出现1例不良事件。两组在术后病程或重复干预需求方面无差异。
与手术结果相比，心脏计算机断层扫描和心脏导管插入术在二期单心室姑息治疗前评估解剖结构方面同样准确。由于血管通路和麻醉风险降低、辐射和造影剂暴露减少以及不良事件较少，计算机断层扫描可能是部分患者的首选检查。
