Cardiac CT in Infants with Congenital heart disease Sunrise Session LaDonna Malone, MD May 17, 2018
None Disclosures
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
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
Pulmonary Veins
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
JA 1 day old with heterotaxy Supracardiac TAPVR
JA 1 day old with Heterotaxy
DC 3 day old with abnormal pulmonary venous drainage Mixed TAPVR Supra and Intra cardiac
AC newborn
AC - TAPVR Infracardiac type Nearly always narrowing as crosses below diaphragm and possibly at insertion
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
JA hx of TAPVR repair now with concern for PV stenosis Right upper and lower pulmonary vein stenosis
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
Possible bpd with pulmonary stenosis here
Pulmonary Arteries
Pulmonary arteries Where is pulmonary blood supply coming from? Ductus arteriosus MAPCAs Both Are branch pulmonary arteries confluent? Size and presence of focal stenoses
EB Newborn with pulmonary atresia Ductal dependent Confluent branch pulmonary arteries
New mapca case
AB Pulmonary atresia with MAPCAs s/p unifocalization, on ECMO Multifocal narrowing in unifocalized arteries
Surgical Shunts
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
BT shunt Oct 2013, Frontiers in Pediatrics
PB 3 mo sp BTS with desaturations Diffuse narrowing of BTS
PB BTS narrowing sp stent Before After
MS 2 wk sp BTS & TAPVR repair with cardiac arrest Thrombus in BTS Patient underwent BTS removal and Sano shunt
Sano shunt Oct 2013, Frontiers in Pediatrics
TM 4 mo old with HLHS s/p Norwood Sano Widely patent RV to PA conduit
YL 3 mo s/p Norwood Sano Multiple areas of mild narrowing in Sano Shunt
CH 5 mo s/p Norwood Sano Severe narrowing of Sano Shunt near RV & PA anastamoses
CH 5 mo s/p Norwood Sano
Central Shunt Oct 2013, Frontiers in Pediatrics
NM 4 mo with Ebsteins sp Starnes and central shunt
NM 4 mo with Ebsteins sp Starnes and central shunt
AH history of Pulmonary atresia sp central shunt with desaturations
AH heterotaxy with Pulmonary atresia sp central shunt with desaturations
Pulmonary veins Summary Anomalous venous return Pulmonary venous confluence and relationship to left atrium Look for obstruction Include upper abdomen if suspect Infra cardiac
Summary Pulmonary vein stenosis Look for significant narrowing as well as upstream dilation or delayed drainage (compared to contralateral side)
Pulmonary arteries Summary Confluent branch Pas Source of pulmonary blood flow ductus, MAPCAs, both Palliative shunts (BTS, Sano, Central) Stenosis or occlusion
Any Questions?
Special thanks to Thank you! Children s Colorado Cardiac CT Imaging Lorna Browne Jason Weinman Andrew Mong 3D Technologist Janet McGee
References