Rajiah Prabhakar Shantha, Sardá María José, Ashwath Ravi, Goerne Harold
From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002 (P.S.R.); Speciality Hospital, IMMS Western National Medical Center, Guadalajara, Mexico, and UdG, Health Science University Center, Guadalajara, Mexico (M.J.S.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); and Pediatric Hospital, Western National Medical Center, IMSS, Guadalajara, Mexico, and Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.).
Radiographics. 2023 Apr;43(4):e220049. doi: 10.1148/rg.220049.
Palliative procedures are performed for congenital heart diseases that are not amenable for definitive surgical procedures or as a component of hybrid procedures along with transcatheter interventions. Multimodality imaging plays an important role in the follow-up of these palliative procedures, mainly for the timely detection of complications and for planning any subsequent palliative or definitive procedure. Echocardiography is the first-line imaging modality, with CT and MRI used as complementary techniques in indeterminate cases. MRI provides anatomic, functional, flow, and tissue characterization information. CT is performed for the evaluation of vascular anatomy and when MRI cannot be performed due to contraindications, challenges, or artifacts. The modified Blalock-Taussig shunt procedure is the most common systemic-pulmonary artery (PA) shunt procedure, with thrombus being the most serious complication. Other complications of systemic-PA shunts include shunt stenosis, infection, pulmonary overcirculation, and cardiac failure. The Glenn shunt procedure is the second stage of palliation in single ventricle physiology, with thrombus, stenosis, superior vena cava syndrome, and infection being the common complications. The Fontan shunt procedure is the third stage of palliation in single ventricle physiology. Complications can be cardiovascular (heart failure, valve regurgitation, thromboembolism, shunt stenosis, arteriovenous malformation), venolymphatic (collaterals, protein-losing enteropathy, plastic bronchitis), or hepatic (congestion, cirrhosis, portal hypertension). PA banding is used to decrease pulmonary flow or to train the systemic ventricle. Complications include stenosis, thrombus, erosion, pseudoaneurysm, and subaortic obstruction. Atrial septostomy and atrial switch procedures are performed for increasing intracardiac mixing. Complications of atrial septostomy can be mechanical, traumatic, embolic, or electrical. Complications of the atrial switch procedure include baffle stenosis, baffle leak, and systemic ventricle failure. The authors review the role of multimodality imaging in the evaluation of these palliative procedures. RSNA, 2023 See the invited commentary by Bardo and Popescu in this issue. Quiz questions for this article are available through the Online Learning Center.
姑息性手术用于治疗无法进行根治性手术的先天性心脏病，或作为与经导管介入治疗相结合的杂交手术的一部分。多模态成像在这些姑息性手术的随访中起着重要作用，主要用于及时发现并发症以及规划任何后续的姑息性或根治性手术。超声心动图是一线成像方式，在诊断不明确的情况下，CT和MRI作为辅助技术使用。MRI可提供解剖、功能、血流和组织特征信息。CT用于评估血管解剖结构，以及在因禁忌症、挑战或伪影而无法进行MRI检查时使用。改良的Blalock-Taussig分流术是最常见的体肺分流术，血栓是最严重的并发症。体肺分流术的其他并发症包括分流狭窄、感染、肺循环过度和心力衰竭。Glenn分流术是单心室生理姑息治疗的第二阶段，血栓、狭窄、上腔静脉综合征和感染是常见并发症。Fontan分流术是单心室生理姑息治疗的第三阶段。并发症可能是心血管方面的（心力衰竭、瓣膜反流、血栓栓塞、分流狭窄、动静脉畸形）、静脉淋巴方面的（侧支循环、蛋白丢失性肠病、塑料支气管炎）或肝脏方面的（充血、肝硬化、门静脉高压）。肺动脉环扎术用于减少肺血流量或训练体循环心室。并发症包括狭窄、血栓、侵蚀、假性动脉瘤和主动脉下梗阻。房间隔造口术和心房调转术用于增加心内混合。房间隔造口术的并发症可能是机械性、创伤性、栓塞性或电性的。心房调转术的并发症包括挡板狭窄、挡板渗漏和体循环心室衰竭。作者回顾了多模态成像在评估这些姑息性手术中的作用。RSNA，2023 见本期Bardo和Popescu的特邀评论。本文的测试题可通过在线学习中心获取。
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