Abstract
This paper aims to assess the usability and advantages of three-dimensional rotational angiography (3DRA) in patients with congenital heart disease (CHD) and its application in the cath lab. Up to now, its use in CHD is not widespread or standardized. We analyzed all patients with CHD who underwent a 3DRA at our facility between January 2010 and May 2019. The 3DRAs were evaluated for radiation exposure, contrast dye consumption, diagnostic utility and image quality. We performed 872 3DRAs. 3DRA was used in 67.1% of the cases for interventional procedures and in 32.9% for diagnostic purposes. Two different acquisition programs were applied. The median dose-area product (DAP) for all 872 rotations was 54.1 µGym2 (21.7–147.5 µGym2) and 1.6 ml/kg (0.9–2.07 ml/kg) of contrast dye was used. Diagnostic utility of the generated 3D-model was rated superior to the native 3D angiography in 94% (819/872). 3DRA is an excellent and save diagnostic and interventional tool. However, 3DRA has not become a standard imaging procedure in pediatric cardiology up to now. Effort and advantage seems to be unbalanced, but new less invasive techniques may upgrade this method in future.
Highlights
The 3DRA, called flat detector computed tomography (FD-CT) or cone beam CT, was developed in the 1990s and initially used for neuroradiology procedures
All interventional and diagnostic 3DRAs were analyzed for radiation exposure, contrast consumption and the diagnostic advantage of the 3D-models achieved by post processing over the native 3D angiography
We investigated all patients (n = 507) who underwent a diagnostic or interventional 3DRA in this group
Summary
The 3DRA, called flat detector computed tomography (FD-CT) or cone beam CT, was developed in the 1990s and initially used for neuroradiology procedures. In 2010, Glatz et al presented the first systematic analysis of 3DRA in the cardiac catheterization laboratory for patients with CHD10. CT-like soft tissue image quality is acquirable due to continuous development of this technique[2]. This technique requires X-ray, a high volume contrast injection and is acquired intraprocedural with obstruction of the continuous course of catheterization. We evaluated usability and possible benefit of 3DRA in patients with CHD, with regard to other less invasive technologies that may replace this technique in the future
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