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Dual-source Computed Tomography in Paediatric Congenital Heart Disease Patients
Figure 1: 3D Visualisation of a Right Pulmonary Artery in a Figure 2: 3D Visualisation of an Anomalous Origin of the
Four-month-old Baby Presenting with Pulmonary Atresia Right Coronary Artery from the Left Sinus in a Child with
Tetralogy of Fallot
The right pulmonary artery is fed by a shunt (Blalock anastomosis between innominate artery and right There is no evidence of compression of the anomalous artery.
pulmonary artery). RCA = right coronary artery; LAD = left anterior descending; Ao = aorta; PA = pulmonary artery.
RPA = right pulmonary artery; IA = innominate artery; B = Blalock anastomosis; LCA = left carotid artery.
Anatomical Assessment temporal resolution up to 43ms. In older CHD patients, if the patient can
hold his or her breath for a sufficient time, ECG-gated acquisition is the
Pulmonary Arteries technique of choice. Free-motion artefact visualisation makes it possible to
Pulmonary artery evaluation is required in pulmonary atresia with precisely evaluate the coronary artery tree. The heart rate may be lowered
ventricular septal defect, tetralogy of Fallot, truncus arteriosus or with the help of beta-blockers. The maximum setting of the tube current is
suspicion of pulmonary sling.
11
For pulmonary artery visualisation, we also carefully selected and adapted to the patient’s anatomy.
13,14
If axial and
usually do not use ECG-gated acquisition. With DSCT, we usually use maximum intensity projection images are insufficient for diagnosis, the
0.6mm collimation and obtain a 1mm slice width with an increment volume-rendering technique may provide comprehensive imaging of the
of 0.5mm. High resolution is advantageous for pulmonary artery coronary artery anomaly (see Figure 2).
stenosis evaluation. For neonates or infants below seven years of age,
start delay is either 15 seconds (peripheral venous access) or 10 seconds Aorta and Collaterals
(central venous access). In older patients (over six years of age), we may Evaluation of the aortic anatomy is essential in cases of aortic coarctation or
use the bolus tracking technique for optimisation of start delay. For for suspicion of aortic arch anomalies: complete or incomplete double aortic
reconstructions, 3D images are currently performed using maximum- arches (see Figure 3), right aortic arches or cervical arches are very clearly
intensity projection, multiplanar reformations and volume-rendering seen with 3D CT images. In cases of pulmonary atresia with ventricular
techniques (see Figure 1). septal defect, the major aorto-pulmonary collateral arteries often originate
from the start of the descending aorta; evaluation of the size and spatial
Coronary Arteries relationship of these arteries is of primary importance for planning surgical
Anomalous coronary arteries are frequently associated with CHD. A intervention. Thin collimation (1mm slice thickness or lower) is of interest to
frequent anomalous finding is a left coronary artery originating from the obtain high-resolution aortic images, especially in cases of aortic coarctation
right coronary sinus, but many variants are possible. In patients with for a better evaluation of vessel narrowing. For reconstructions, 3D images
tetralogy of Fallot, detection of an anomalous origin of coronaries is are currently performed using maximum-intensity projection, mutliplanar
especially important before surgery when a ventriculotomy is planned, as reformations and volume-rendering techniques.
accidental lesions of the coronary artery crossing the right ventricle during
intervention can be fatal. If non-ECG-gated acquisition is insufficient to Upper Airways
visualise coronary origins,
12
in neonates we recommend ECG-gated Compression of the central airways of vascular origin may be due to various
acquisition using DSCT to improve coronary anatomy visualisation.
4
Due to situations: the most frequently observed are aortic arch anomalies,
the very high heart rate in babies, the maximal temporal resolution is pulmonary artery sling, dilated pulmonary arteries or posteriorly displaced
required: bi-segmental reconstructions may therefore be useful to increase aorta after switch intervention. In 20 consecutive cases of vascular
EUROPEAN CARDIOLOGY 43
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