Value of 3D Rotational Angiography in Congenital Heart Diseases

Abstract

Abstract Background Cardiac catheterization continues to be the gold standard in the management of CHD because of its diagnostic accuracy and therapeutic advantages. Among the recent advances in cardiac catheterization is the use of 3DRA which has been introduced in CHDs nearly 10 years ago after its long use in neuroradiology with good outcomes. Objective The aim of this work is to describe our initial experience with rotational angiography at Ain Shams University and compare between conventional and rotational angiography in terms of contrast, radiation and procedure time. Patients and Methods The study included 100 patients presenting to Ain Shams University Hospital pediatric cath lab in the period between February 2017 and July 2018. Fifty patients underwent rotational angiography (RA) and 50 underwent conventional angiography. The 2 groups were matched regarding age, sex, weight, diagnosis and the procedure performed. Results The median age in the study was 4 years with a median weight of 15.5 kg. The study included 44 patients with PDA, 42 (95%) underwent PDA closure. 30 patients had PS of which 28 underwent BPV (93%). 8 patients had CoA, 6 had CoA balloon +/- stenting (75%). 12 patients were postGlenn, 2 had TOF, 2 had AS and 2 had history of TOF repair with either RPA or LPA stenosis. Diagnostic quality imaging was obtained in 74% of cases. The RA cases were divided into earlier and later groups which were compared with each other and with the conventional angiography group. The procedure time decreased significantly in the later RA cases (38 minutes compared to 49 minutes in earlier cases) but was still significantly more than the conventional angiography group (33 minutes). Total contrast decreased in later cases (3.56 ml/kg) but was still more than conventional angiography cases (2.55 ml/kg). Less DAP was needed in later RA cases than earlier cases and conventional cases (10 Graycm2, 24 Graycm2 and 16 Graycm2 respectively). The more procedure time in RA group can be explained by the time lost in preparing the room for 3DRA and processing of the reconstructed image. The more contrast is related to the routine use of biplane in conventional group and the simplicity of procedures involved in our study requiring little contrast and fewer injections in conventional angiography. Conclusion RA can be safely performed in diagnostic and interventional cases for better visualization of extra cardiac structures with significant reduction of radiation exposure on the expense of some more time and contrast. RA requires time to master it in a way that makes it a valuable additional tool in the cath lab.