Lucas Chenise N, Slieker Martijn G, Molenschot Mirella M C, Breur Hans M P J, Krings Gregor J
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center of Utrecht, Utrecht, the Netherlands.
J Soc Cardiovasc Angiogr Interv. 2024 Dec 19;3(12):102391. doi: 10.1016/j.jscai.2024.102391. eCollection 2024 Dec.
Three-dimensional rotational angiography (3DRA) is a promising advancement to guide cardiac catheterizations. It is used with restraint in critically ill infants with congenital heart disease (CHD) due to the lack of research conducted within this patient group.
Data of all infants with CHD and a body weight <5 kg who underwent cardiac catheterization with the use of 3DRA between November 2011 and April 2021 were retrospectively analyzed. Primary outcome measures were 3DRA-related periprocedural deaths or major adverse events (MAEs). Secondary outcome measures were 3DRA-related minor adverse events (MiAEs), the amount of radiation exposure and contrast agent, and whether 3DRA led to important new findings. The case-based workflow of 3DRA in vulnerable infants is explained.
Eighty-six patients underwent 109 cardiac catheterizations in which 132 3DRA scans were performed. Median age and weight were 50.0 days (IQR, 20.0-98.5) and 3.8 kg (IQR, 3.2-4.5). There were no periprocedural deaths or MiAEs, and only 2 MAEs occurred, both concerning ventricular fibrillation. The median radiation exposure was 160.0 cGy⋅cm (IQR, 81.3-257.5), of which 28.0 cGy⋅cm (IQR, 19.4-43.0) was derived from 3DRA. The mean amount of contrast agent used was 4.8 ± 1.6 mL/kg. In 70.6%, 3DRA imaging led to important new findings. Multivariate binary logistic regression analysis showed the presence of comorbidity to be associated with a lower odds of receiving a 3DRA-derived radiation dose ≥15 cGy⋅cm ( = .01). Additionally, the interval between surgery and cardiac catheterization was significantly associated with higher odds of a contrast dye consumption ≥6 mL/kg ( = .046).
3DRA proved to be safe in vulnerable infants with CHD weighing <5 kg, enabling visualization of anatomical substrates often invisible in conventional angiography. However, when an advanced computed tomography scanner is available, the diagnostic purposes for 3DRA are few. The greatest benefit of 3DRA usage is interventional guidance (3D roadmap).
三维旋转血管造影（3DRA）是指导心脏导管插入术的一项有前景的进展。由于在先天性心脏病（CHD）危重症婴儿群体中缺乏相关研究，其在该群体中的使用受到限制。
回顾性分析2011年11月至2021年4月期间所有体重<5kg且接受3DRA引导心脏导管插入术的CHD婴儿的数据。主要结局指标为3DRA相关的围手术期死亡或主要不良事件（MAE）。次要结局指标为3DRA相关的轻微不良事件（MiAE）、辐射暴露量和造影剂用量，以及3DRA是否带来重要的新发现。解释了3DRA在脆弱婴儿中的基于病例的工作流程。
86例患者接受了109次心脏导管插入术，共进行了132次3DRA扫描。中位年龄和体重分别为50.0天（IQR，20.0 - 98.5）和3.8kg（IQR，3.2 - 4.5）。围手术期无死亡或MiAE发生，仅发生2例MAE，均为心室颤动。中位辐射暴露量为160.0 cGy⋅cm（IQR，81.3 - 257.5），其中28.0 cGy⋅cm（IQR，19.4 - 43.0）来自3DRA。造影剂平均用量为4.8±1.6 mL/kg。70.6%的情况下，3DRA成像带来了重要的新发现。多因素二元逻辑回归分析显示，合并症的存在与接受≥15 cGy⋅cm的3DRA衍生辐射剂量的较低几率相关（P = 0.01）。此外，手术与心脏导管插入术之间的间隔与造影剂消耗量≥6 mL/kg的较高几率显著相关（P = 0.046）。
3DRA在体重<5kg的CHD脆弱婴儿中被证明是安全的，能够显示传统血管造影中常不可见的解剖结构。然而，当有先进的计算机断层扫描扫描仪可用时，3DRA的诊断用途有限。使用3DRA的最大益处是介入指导（3D路线图）。
