Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, 6410 Fannin Street, UTPB Suite 425, Houston, TX, 77030, USA.
Section of Pediatric Cardiac MRI And Pediatric Cardiac CT, Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
Pediatr Cardiol. 2024 Oct;45(7):1581-1587. doi: 10.1007/s00246-023-03234-6. Epub 2023 Jul 21.
There is limited experience in evaluating abnormal ductus arteriosus (DA) insertion pattern by contrast-enhanced cardiac computed tomography (cardiac CT) in patients with right-sided obstructive cardiac defects. Retrospective review of 38 infants with right-sided obstructive cardiac defects who underwent a preoperative cardiac CT between 2016 and 2021. We reviewed the types of cardiac lesions, patterns of ductal insertion, frequency of pulmonary artery (PA) stenosis requiring intervention, total dose length product (DLP), and effective radiation dose. Of 38 infants, 45% were female, the median gestational age and weight were 37 (range 34-40) weeks and 2.95 (range 2-4) kg. The most common pathologies were pulmonary atresia with ventricular septal defect (24%) and tetralogy of Fallot (24%). The abnormal ductal insertion patterns were DA inserting into the left PA in 39%, DA bifurcating into branch PA in 32%, and DA inserting into the right PA in 13%. Of the 38 infants, 76% developed branch PA stenosis requiring intervention. Among patients with abnormal DA insertion, 44% required branch PA arterioplasty during their index surgery compared to 17% without abnormal DA insertion. Regardless of the type of abnormal DA insertion, 67% developed bilateral branch PA stenosis over time. The mean DLP was 8 mGy-cm and the mean calculated effective radiation dose was 0.312 mSv. The utilization of contrast-enhanced cardiac CT in infants with right-sided obstructive heart defects can offer crucial insights into abnormal ductus arteriosus insertion patterns. This information is valuable for effective procedure planning and for monitoring the development of branch pulmonary artery stenosis.
在伴有右侧心内阻塞性畸形的患者中，经对比增强型心脏 CT 评估异常动脉导管（ductus arteriosus，DA）插入模式的经验有限。对 2016 年至 2021 年期间接受术前心脏 CT 的 38 例伴有右侧心内阻塞性畸形的婴儿进行回顾性分析。我们分析了心脏病变类型、导管插入模式、需要介入治疗的肺动脉（pulmonary artery，PA）狭窄的频率、剂量长度乘积（dose length product，DLP）和有效辐射剂量。38 例婴儿中，45%为女性，中位胎龄和体重分别为 37（范围 34-40）周和 2.95（范围 2-4）kg。最常见的病变是伴有室间隔缺损的肺动脉瓣闭锁（pulmonary atresia with ventricular septal defect，PA-VSD）（24%）和法洛四联症（tetralogy of Fallot，TOF）（24%）。异常的导管插入模式包括导管插入左肺动脉 39%、导管分叉入分支肺动脉 32%和导管插入右肺动脉 13%。38 例婴儿中，76%出现分支 PA 狭窄需要介入治疗。在异常 DA 插入的患者中，44%的患者在其指数手术中需要进行分支 PA 成形术，而无异常 DA 插入的患者中仅为 17%。无论 DA 插入的类型如何，67%的患者随着时间的推移会出现双侧分支 PA 狭窄。平均 DLP 为 8mGy-cm，平均计算出的有效辐射剂量为 0.312mSv。在伴有右侧心内阻塞性畸形的婴儿中使用增强型心脏 CT 可提供有关异常动脉导管插入模式的关键信息。这些信息对于有效规划手术和监测分支肺动脉狭窄的发展具有重要意义。
