Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
Virtual Radiologic Corporation, Eden Prairie, MN, USA.
Pediatr Radiol. 2021 Jun;51(7):1185-1191. doi: 10.1007/s00247-021-04966-4. Epub 2021 Feb 4.
The Norwood procedure is the first part of a three-stage surgical palliation for patients with functionally single ventricle anatomy. Complications after the stage I operation are not uncommon. Transthoracic echocardiography (TTE) is traditionally the mainstay for evaluation.
The purpose of our study is to compare gated cardiac computed tomographic angiography (CCTA) with TTE when evaluating for postoperative complications after stage I Norwood procedure and to describe management implications.
A retrospective chart review of all patients over a 4-year period who underwent nonelective urgent CCTA for suspected complications related to stage I Norwood procedure was performed. Elective CCTA studies before stage II palliation were excluded. Patient demographics, CCTA and TTE findings, as well as interventions performed, were recorded.
Thirty-four patients were included. The mean age at CCTA was 63 days (range: 4-210 days). All patients had a recent TTE with a mean time interval between TTE and CCTA of 2 days. CCTA detected 56 abnormalities in 30 patients, with 23 directly related to postsurgical complications, including shunt-related complications (10/23, 43%), Damus-Kaye-Stansel anastomotic narrowing (2/23, 9%) and neo-aortic arch/branch vessel abnormalities (11/23, 48%). These complications were managed as follows: surgery (9, 39%), catheter-based intervention (7, 30%), medical (4, 17%) and no change in management (3, 13%). TTE did not detect 8/23 (35%) findings found on CCTA, of which 75% were either managed with surgery (4/8, 50%) or catheter-based intervention (2/8, 25%).
CCTA plays an important role in detecting surgical complications after stage I Norwood procedure and demonstrates additional findings that have direct management implications.
Norwood 手术是功能性单心室解剖患者三阶段手术姑息治疗的第一部分。一期手术后的并发症并不少见。经胸超声心动图（TTE）传统上是评估的主要方法。
本研究旨在比较门控心脏 CT 血管造影（CCTA）与 TTE 在评估一期 Norwood 手术后并发症中的作用，并描述其管理意义。
对 4 年内因疑似一期 Norwood 手术后并发症而进行非紧急紧急 CCTA 的所有患者进行回顾性图表审查。排除二期姑息治疗前的选择性 CCTA 研究。记录患者的人口统计学、CCTA 和 TTE 结果以及进行的干预措施。
共纳入 34 例患者。CCTA 的平均年龄为 63 天（范围：4-210 天）。所有患者均行近期 TTE，TTE 与 CCTA 之间的平均时间间隔为 2 天。CCTA 在 30 例患者中发现了 56 处异常，其中 23 处与术后并发症直接相关，包括分流相关并发症（10/23，43%）、Damus-Kaye-Stansel 吻合口狭窄（2/23，9%）和新主动脉弓/分支血管异常（11/23，48%）。这些并发症的处理如下：手术（9 例，39%）、导管介入（7 例，30%）、药物（4 例，17%）和无改变管理（3 例，13%）。TTE 未发现 CCTA 上发现的 23 处（8/23，35%）发现中的 8 处，其中 75%的发现通过手术（4/8，50%）或导管介入（2/8，25%）进行处理。
CCTA 在检测一期 Norwood 手术后的手术并发症方面发挥着重要作用，并显示出具有直接管理意义的其他发现。
