THE ROLE OF ULTR-FAST CT
IN THE DIAGNOSIS OF ATIAl L SEPTAL DEFECTS AND PARTIAL ANOMALOUS PULMONARY
VENUS RETURN
Kamel MM.*, Husayni T.**, Roberston D.**, Ilbawi M.**, and Arcilla R.**
* Pediatric Department,
El-Minia University Hospital, El-Minia, Egypt
**
The Heart Institute for Children, Hope Children’s Hospital, Oak Lawn,
Illinois USA
Background: Atrial Septal Defects (ASDs) and
Partial Anomalous Pulmonary Venous Return (PAPVR) are relatively two of the
most frequent congenital heart lesions producing right heart volume
overload. Although generally
well tolerated during childhood, exercise intolerance, arrhythmias,
pulmonary hypertension, paradoxical embolism, and congestive heart failure
appear later in adulthood.
Transthoracic echocardiography (TTE) is usually effective for their
diagnosis in children, however; its accuracy may be limited in large or
older subjects and cardiac catheterization (CC) is then required. The
purpose of this study is to assess the value of ultrafast cine computed tomography
(UFCT) to diagnose ASDs and PAPVR in a wide spectrum of patients age and
size as compared to other non-invasive imaging systems, namely
transthoracic and transesophageal echocardiography.
Methods: The study population is 36 patients, 21
children and 15 adults, age 4/12 to 45 years, and weight 4.8 to 83
kgs. Diagnosis included:
secundum ASD (SASD) in 21, sinus venosus ASD (VASD) in 7, and PAPVR in
8. Patients with primum ASD
were excluded. All patients
had TTE, 14 had intra-operative transesophageal echo, 20 had CC, and all
had a surgical repair. UFCT
flow studies using time-density curves from single contrast bolus
injections and high resolution imaging during constant infusion were
obtained. These provided the anatomy of pulmonary veins and atrial septum,
size/thickness/function of right ventricle and identified the
direction/magnitude/localization of shunting.
Results:
UFCT diagnosed all 21 patients with (SASD), all 7 patients with
(VASD), and failed to diagnose PAPVR in one patient where only a flow study
was done, i.e. without high resolution imaging. In contrast, TTE failed to
demonstrate (SASD) in 5 patient and (VASD) in 4 patients, all of whom were
adult subjects. It also failed
to identify the PAPVR in 5 out of 8 patients, two of whom were children.
TEE showed all 10 patients with SASD and failed to show 1 out of 4 patients
with VASD. Non of the partial veins were imaged with TEE.
Conclusion:
TTE is of limited value
in large subjects with ASD or PAPVR. UFCT is the diagnostic procedure of choice
short of invasive cardiac catheterization.