From the Departments of Radiology (M.G.M., S.F.D., R.A.W.) and Pediatrics, Division of Pediatric Cardiology (J.C.L., A.L.D.), C.S. Mott Children's Hospital, 1540 E Hospital Dr, SPC 4252, Ann Arbor, MI 48109-4252; University of Michigan Health Center, Ann Arbor, Mich (P.P.A.); Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill (C.K.R.); and Texas Children's Hospital, Baylor College of Medicine, Houston, Tex (R.K.).
Radiographics. 2016 Sep-Oct;36(5):1273-84. doi: 10.1148/rg.2016150233.
The total cavopulmonary connection (TCPC), or Fontan procedure, diverts systemic venous blood directly into the pulmonary arteries and is the palliative surgery of choice for patients with a wide variety of congenital heart diseases with single-ventricle physiologic characteristics. Pulmonary embolism and thrombosis are known complications and are among the major causes of morbidity and mortality in patients after TCPC. Magnetic resonance (MR) imaging is usually performed for postoperative evaluation of patients after single-ventricle repair; however, screening for thrombosis or embolism with MR imaging is not always feasible because of the emergent nature of the clinical presentation or because of artifacts from metallic devices or coils. Computed tomographic (CT) angiography is an effective method for diagnosing pulmonary embolism in children. However, because of altered hemodynamics after single-ventricle palliation, there are unique challenges in achieving optimal opacification of the pulmonary arteries and Fontan circuit that can result in nondiagnostic CT angiographic studies or erroneous image interpretation. Radiologists should be familiar with the multiple stages of single-ventricle palliation, understand the technique for performing pulmonary CT angiography at each stage, and recognize common pitfalls in obtaining and interpreting pulmonary CT angiographic images in patients who have undergone single-ventricle repair. Online supplemental material is available for this article. (©)RSNA, 2016.
全腔静脉肺动脉连接术（TCPC），又称 Fontan 手术，将体循环静脉血直接引流入肺动脉，是具有单心室生理特征的多种先天性心脏病患者的姑息性手术选择。肺栓塞和血栓形成是已知的并发症，也是 TCPC 术后患者发病率和死亡率的主要原因之一。磁共振（MR）成像通常用于单心室修复术后患者的术后评估；然而，由于临床表现的紧急性质或由于金属器械或线圈的伪影，MR 成像筛查血栓形成或栓塞并不总是可行。计算机断层（CT）血管造影是诊断儿童肺栓塞的有效方法。然而，由于单心室姑息治疗后的血液动力学改变，在实现肺动脉和 Fontan 环的最佳显影方面存在独特的挑战，这可能导致 CT 血管造影研究无诊断价值或图像解释错误。放射科医生应熟悉单心室姑息治疗的多个阶段，了解在每个阶段进行肺动脉 CT 血管造影的技术，并认识到在接受单心室修复的患者中获得和解释肺动脉 CT 血管造影图像的常见陷阱。本文提供了在线补充材料。（©）RSNA，2016。
