If echo or magnetic resonance are not enough to assess a patient with congenital heart disease, think of ECG gated computed tomography. Case series from a second level hospital

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Congenital heart disease (CHD) is evaluated by echocardiogram, and if doubts, there may be necessary other exams, generally magnetic resonance (MRI). Due to radiation concerns, computed tomography (CT) is seldom performed. Depending of different cardiac procedures, radiation exposure to the patients varies, ranged from almost 4 mSv approx. for coronariography alone to 15 mSv approx. if stenting and ventriculography are added. ECG-gated CT can be used in cases of CHD because of its better spatial resolution if other examinations are not enough. Methods We reviewed ECG-gated CT performed at our institution to evaluate patients with CHD (suspected or previously known). Characteristics of the patients and the exams were reported, including other cardiovascular or extracardiac findings. Results There were 5 exams in 4 patients, all of them with contrast. 2 patients were women, 1 of them with two exams (cases No 4 and 5). Mean age was 45.4 years (range 17-59). CT was chosen due to better spatial resolution (including 1 patient which previous MRI was inconclusive), except in one patient, that was performed because of cardiac device that contraindicated MRI. This patient had repeated exams. All of them were in sinusal rhythm. The patient with repeated exams was previously diagnosed of CHD, whereas, in the rest of cases the final diagnosis was made by CT. 3 examinations were retrospective. Coronary arteries were also evaluated in 3 cases (in all prospective studies and one retrospective). Mean radiation exposure was 6.22 mSv (1.2 to 10.7). In prospective studies, it was 1.85 mSv (1.6 and 2.1 mSv) and in retrospective ones were 9.13 mSv (8.2 to 10.7 mSv). There were no complications. In all cases, other cardiovascular findings other than CHD were reported. In 3 cases, other extracardiovascular findings were noted. Characteristics of patients are listed in figure 1 and images from the studies are shown in figure 2. Yellow arrows show the congenital defects. Conclusions Although patients with congenital heart disease are generally evaluated by other imaging techniques, they can be evaluated by ECG-gated CT if necessary, with similar radiation exposure to other cardiac interventional procedures, and coronary angiography and other cardiovascular or extravascular findings can also be assessed. Abstract Table: Characteristics of patients Abstract Figure. Images from exams