Additional Value of 3DRA in the Diagnostic Evaluation and Percutaneous Treatment of Children With Univentricular Hearts

Transcription

1 Additional Value of 3DRA in the Diagnostic Evaluation and Percutaneous Treatment of Children With Univentricular Hearts 3DI3 symposium 2016 October 15th Mirella Molenschot, Femke vd Stelt, Hans Breur, Gregor Krings

2 Additional value of 3DRA in Single Ventricle Background Aim of this study Methods Results Conclusion

3 Background 100% 90% 80% 70% 3D rotational angiography Conventional angiography 60% 50% 40% 30% 20% 10% 0% < Year

4 Background : Conventional Angiography (CA)

5 Background : 3DRA workflow multi location injection SV : double Flow (high C.O. Stage I+II) rapid pacing (Stage I + II +/- III) Reconstruction after dataset duplication

6 Background : 3DRA

7 Background : 3DRA Background study aim Methods Results Discussion Conclusion

8 Background : 3DRA

9 Study aim 1. Evaluate the diagnostic accuracy and additional value of 3DRA compared to conventional angiography (CA) in children with univentricular hearts. 1. Setup of imaging protocol Background study aim Methods Results Discussion Conclusion

10 Methods Design Inclusion Retrospective Pts < 18y, UVH Cath pre-pcpc/tcpc or aortic/pa intervention Time frame conventional Angio(CA) < DRA (Artis Zee, Siemens) > 2011 Data collection demographic / clinical / cath Image quality & additional value score Interventions & interventional success complications

11 Results Inclusion 128 patients (78 male) 242 catheterizations 186 CA 56 3DRA s

12 Results

13 Results : Image quality Conventional angiography 3DRA Structure % of good quality % of good quality p-value Single ventricle Aorta Coronary arteries difficult Right pulmonary to artery compare Left pulmonary artery Conventional Shunt Angio Right superior vena cava DRA Left superior vena cava scored 84.6 good offering maximal 100 3D info 0.19 Inferior vena cava Innominate vein Left jugular vein scored good being conventionally good

14 Results : additional value Collaterals Airway-vessel interaction Vessel-vessel interaction Virtual angulations Roadmap The unexpected.

15 Results : interventions 128 interventional caths Bias 222 interventions CA: 45% (n=145) 3D: 79% (n=77) p = balloon (re-coa, PA stenosis) 51 stents (re-coa, PA stenosis, shunt stenosis) 109 collaterals Conventional Angio 3DRA 4 thrombus removals 2 other Success rate old strategy CA: 87.6%; 3DRA: 94.8% p = more contemporary interv. strategy

16 Results : complications Procedural complications 12 in CA (6.5%) 4 in 3DRA (7.1%) p = 0.77 Interventional complications 13 in CA (8.9%) 7 in 3DRA (9.1%) P = 0.98

17 Results : number of angio s

18 Results : radiation Dosis Area Product (μgy/m 2 ) 0,8 /frame -75% r 2 = 0,7497 0,4 msv Calibration fault 1,5 /frame 1,6 msv Effective dose (msv)

19 Results : radiation

20 Conclusions 3DRA provides excellent imaging of univentricular hearts in all stages of palliation 3DRA is superior to CA in displaying shunts, collaterals and coronary anatomy Not at the expense of more radiation / more contrast / more complications Essential additional information all in one run

21 Thank you Pediatric Cardiology Department Wilhelmina Children s Hospital Utrecht: Gregor Krings Hans Breur Femke vd Stelt Special thanks to Aimee Armstrong

22