“Can computed tomographic angiography” solve the puzzle of complexities in the pediatric complex congenital heart disease’s

Abstract

ABSTRACT Background: Accurate evaluation of cardiac and extracardiac anomalies in complex congenital heart diseases (CHDs) is vital for diagnosis and management. Trans-thoracic echocardiography (TTE) is generally accepted as the primary imaging technique for the evaluation of CHD; however being operator-dependent and acoustic window limitations, there can be significant hindrances in better evaluation and depiction of cardiac and extracardiac malformations. Computed tomographic angiography (CTA) has been proven to be a competent noninvasive diagnostic modality in the delineation of both cardiac and extracardiac malformations with high accuracy and effectivity. The aims and objectives were to evaluate the role of CTA in the diagnosis and assessment of cardiovascular and relevant extracardiac systemic malformation in cases of complex CHD and its comparison to transthoracic echocardiography, with subsequent calculation of average effective radiation dose for each individual case. The purpose of the study was to ascertain the role of Cardiac CTA in unraveling these twists and turns, and to know whether additional radiation dose is justified in the evaluation of associated extracardiac systemic anomalies. Materials and Methods: Fifty patients with complex CHD were included in the study, who underwent TTE and nongated CTA over the period of 2 years. CTA and TTE findings were recorded and compared with the Surgical and Cardiac catheter angiographic findings, which were taken as the gold standard. Scans were also evaluated for relevant extracardiac systemic abnormalities, and effective radiation dose was calculated for each scan. Results: Fifty patients with male-to-female ratio of 29:21 and a mean age of 2.7 years. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for diagnosing CHD were 95.83%, 100%, 100%, 99.35%, and 99.44% for CTA and 76.96%, 99.78%, 98.24%, 96.51%, and 96.69% for TTE respectively. We found that CTA has more sensitivity, specificity, NPV, PPV, and diagnostic accuracy than TTE, not only in intracardiac but also in extracardiac and systemic malformations. The total mean effective radiation dose calculated was 0.85 ± 0.19 mSv.mGy−1.cm−1 and is compared with previous comparable studies. Effective radiation dose was significantly reduced by employing low radiation protocols. The additional findings detected on CTA in a significant proportion of patients had changed the operative course for surgeons. Conclusions: CTA has important clinical value in the diagnosis and management of complex CHD, complementing and extending the findings of TTE. Hence, it is vital as part of an adequate preoperative assessment algorithm in cases of complex CHD and can’t be replaced by TTE. However, radiation dose remains a limiting factor, this can be overcome to some extent by employing low radiation dose protocols.