Cardiac CT in Infants with Congenital heart disease Sunrise Session. LaDonna Malone, MD May 17, 2018

Transcription

1 Cardiac CT in Infants with Congenital heart disease Sunrise Session LaDonna Malone, MD May 17, 2018

2 None Disclosures

3 Objectives Describe cardiac CT techniques used in infants with congenital heart disease. Tailor cardiac CT to clinical question including: Evaluation of pulmonary vessels Evaluation of shunts performed for palliation BT, Sano, & central

4 Reviewed CT cases in infants < 4 months of age over last 12 mo 29 cases Pulmonary veins (8) Pulmonary arteries (PA-VSD, PA-MAPCAs) (3) Shunts (BT, Sano, central) (13) Coronary arteries (8)-to be discussed next

5 Pulmonary Veins

6 Pulmonary Veins Anomalous pulmonary venous return Total (TAPVR) Supracardiac, Intracardiac, and Infracardiac Need to evaluate for obstruction, esp. for Infracardiac Partial (PAPVR) Pulmonary vein stenosis

7 JA 1 day old with heterotaxy Supracardiac TAPVR

8 JA 1 day old with Heterotaxy

9 DC 3 day old with abnormal pulmonary venous drainage Mixed TAPVR Supra and Intra cardiac

10 AC newborn

11 AC - TAPVR Infracardiac type Nearly always narrowing as crosses below diaphragm and possibly at insertion

12 Pulmonary vein Stenosis Primary or acquired Acquired Recurrence after prior surgery for pulmonary vein stenosis or prior repair of anomalous pulmonary venous return Sequelae of severe bronchopulmonary dysplasia

13 JA hx of TAPVR repair now with concern for PV stenosis Right upper and lower pulmonary vein stenosis

14 JA hx of TAPVR repair now with concern for PV stenosis RPA LPA Left pulmonary veins not opacified Occluded or severe stenosis Left pulmonary artery delayed opacification

15 Possible bpd with pulmonary stenosis here

16 Pulmonary Arteries

17 Pulmonary arteries Where is pulmonary blood supply coming from? Ductus arteriosus MAPCAs Both Are branch pulmonary arteries confluent? Size and presence of focal stenoses

18 EB Newborn with pulmonary atresia Ductal dependent Confluent branch pulmonary arteries

19 New mapca case

20

21 AB Pulmonary atresia with MAPCAs s/p unifocalization, on ECMO Multifocal narrowing in unifocalized arteries

22 Surgical Shunts

23 Surgical Shunts Part of Stage 1 Palliation surgery (usually) Modified BT shunt Graft from Right subclavian artery to Right pulmonary artery Sano Shunt-Conduit from Right ventricle to pulmonary artery Central Shunt-Graft from Aorta to Pulmonary artery

24 BT shunt Oct 2013, Frontiers in Pediatrics

25 PB 3 mo sp BTS with desaturations Diffuse narrowing of BTS

26 PB BTS narrowing sp stent Before After

27 MS 2 wk sp BTS & TAPVR repair with cardiac arrest Thrombus in BTS Patient underwent BTS removal and Sano shunt

28 Sano shunt Oct 2013, Frontiers in Pediatrics

29 TM 4 mo old with HLHS s/p Norwood Sano Widely patent RV to PA conduit

30 YL 3 mo s/p Norwood Sano Multiple areas of mild narrowing in Sano Shunt

31 CH 5 mo s/p Norwood Sano Severe narrowing of Sano Shunt near RV & PA anastamoses

32 CH 5 mo s/p Norwood Sano

33 Central Shunt Oct 2013, Frontiers in Pediatrics

34 NM 4 mo with Ebsteins sp Starnes and central shunt

35 NM 4 mo with Ebsteins sp Starnes and central shunt

36 AH history of Pulmonary atresia sp central shunt with desaturations

37 AH heterotaxy with Pulmonary atresia sp central shunt with desaturations

38 Pulmonary veins Summary Anomalous venous return Pulmonary venous confluence and relationship to left atrium Look for obstruction Include upper abdomen if suspect Infra cardiac

39 Summary Pulmonary vein stenosis Look for significant narrowing as well as upstream dilation or delayed drainage (compared to contralateral side)

40 Pulmonary arteries Summary Confluent branch Pas Source of pulmonary blood flow ductus, MAPCAs, both Palliative shunts (BTS, Sano, Central) Stenosis or occlusion

41 Any Questions?

42 Special thanks to Thank you! Children s Colorado Cardiac CT Imaging Lorna Browne Jason Weinman Andrew Mong 3D Technologist Janet McGee

43 References