ABSTRACT
BACKGROUND: Transcatheter closure of secundum type atrial septal defect (ASD) has become a standard procedure in most medical centers. Although the procedure is invasive and has a shorter recovery duration and a lower complication rate compared with surgery, it is not risk-free. In this retrospective chart review case series, we report our experience of management of complications after placement of an ASD occluder. METHODS: Between January 2000 and December 2010, a total of 508 patients in our hospital underwent closure of secundum type ASD using an Amplatzer septal occluder (ASO). Six of the patients (1.2%) had device embolization or migration warranting surgical retrieval and repair. RESULTS: All the devices were removed and the defects were repaired successfully without any mortality. CONCLUSIONS: Surgical intervention for complications of ASO placement in patients who underwent closure of secundum type ASD is safe and effective. KEY WORDS: Amplatzer occluder; Atrial septal defect; Surgical management.
ABSTRACT
BACKGROUND: There is little published evidence regarding the patterns and prevalence of vertebral artery (VA) and common carotid artery (CCA) anomalies in patients with an aberrant right subclavian artery (ARSCA). OBJECTIVE: To study the patterns and prevalence of VA and CCA anomalies in patients with ARSCA. MATERIALS AND METHODS: In a 2-year period we reviewed the children referred with suspected vascular ring who had undergone multidetector-row CT. Patients with ARSCA were reviewed for VA and CCA patterns and their prevalence and relevance were calculated. RESULTS: In total, 102 patients with ARSCA were identified. VA anomalies were present in 16 patients (15.7%), and CCA anomalies (common carotid trunk) in 21 patients (20.6%). In some patients with VA anomalies, the right VA arose from the right CCA and in some the left VA arose from the aortic arch. When the left VA arose from the aortic arch it was situated between the left CCA and the left SCA or between the left SCA and the ARSCA. CONCLUSION: If neurointerventionalists understand these potential anomalies and their prevalence, time and contrast medium could be saved when catheterizing the VA and CCA in patients with ARSCA.
Subject(s)
Abnormalities, Multiple/epidemiology , Carotid Arteries/abnormalities , Subclavian Artery/abnormalities , Subclavian Artery/diagnostic imaging , Vertebral Artery/abnormalities , Abnormalities, Multiple/diagnostic imaging , Adolescent , Angiography/statistics & numerical data , Carotid Arteries/diagnostic imaging , Child , Child, Preschool , China/epidemiology , Comorbidity , Female , Humans , Male , Prevalence , Retrospective Studies , Risk Assessment/methods , Risk Factors , Tomography, X-Ray Computed/statistics & numerical data , Vertebral Artery/diagnostic imagingABSTRACT
BACKGROUND: Multidetector CT (MDCT) seems to be a promising tool for detection of neonatal coronary arteries, but whether the ECG-gated or non-ECG-gated technique should be used has not been established. OBJECTIVE: To compare the detection rate and image quality of neonatal coronary arteries on MDCT using ECG-gated and non-ECG-gated techniques. MATERIALS AND METHODS: Twelve neonates with complex congenital heart disease were included. The CT scan was acquired using an ECG-gated technique, and the most quiescent phase of the RR interval was selected to represent the ECG-gated images. The raw data were then reconstructed without the ECG signal to obtain non-ECG-gated images. The detection rate and image quality of nine coronary artery segments in the two sets of images were then compared. A two-tailed paired t test was used with P values <0.05 considered as statistically significant. RESULTS: In all coronary segments the ECG-gated technique had a better detection rate and produced images of better quality. The difference between the two techniques ranged from 25% in the left main coronary artery to 100% in the distal right coronary artery. CONCLUSION: For neonates referred for MDCT, if evaluation of coronary artery anatomy is important for the clinical management or surgical planning, the ECG-gated technique should be used because it can reliably detect the coronary arteries.
Subject(s)
Coronary Vessel Anomalies/diagnostic imaging , Electrocardiography , Heart Defects, Congenital/diagnostic imaging , Tomography, X-Ray Computed/methods , Female , Humans , Infant, Newborn , Male , Radiographic Image Interpretation, Computer-AssistedABSTRACT
OBJECTIVE: Hemodynamic information observed on serial images obtained with bolus tracking might help in diagnosing septal defects on CT. Our purpose was to qualitatively and quantitatively examine a new sign called gradual pulmonary artery enhancement. CONCLUSION: Gradual pulmonary artery enhancement is a newly recognized CT sign that may be helpful in evaluating septal defects.
Subject(s)
Heart Septal Defects/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Radiographic Image Enhancement/methods , Radiographic Image Interpretation, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
OBJECTIVE: The essay describes the protocol for and interpretation of MDCT scans in the evaluation of patients after insertion of an Amplatzer septal occluder. CONCLUSION: In anatomic regions that cannot be confidently evaluated with transthoracic echocardiography, MDCT is useful for evaluating Amplatzer septal occluders for protrusion, migration, and residual shunt. Radiologists should be familiar with the imaging protocol and interpretation.
Subject(s)
Heart Septal Defects, Atrial/surgery , Prosthesis Implantation/instrumentation , Adolescent , Adult , Cardiac Catheterization , Child , Child, Preschool , Female , Humans , Male , Prostheses and Implants/adverse effects , Prosthesis Failure , Prosthesis Implantation/adverse effects , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Echocardiography is the first-line modality for the investigation of neonatal congenital heart disease. Diagnostic cardiac catheterization, which has a small but recognized risk, is usually performed if echocardiography fails to provide a confident evaluation of the lesions. OBJECTIVE: To verify the technical and clinical feasibilities of replacing diagnostic cardiac catheterization with multidetector-row CT (MDCT) in neonatal complex congenital heart disease. MATERIALS AND METHODS: Over a 1-year period we prospectively enrolled all neonates with complex congenital heart disease referred for diagnostic cardiac catheterization after initial assessment by echocardiography. MDCT was performed using a 40-detector-row CT scanner with dual syringe injection. A multidisciplinary congenital heart disease team evaluated the MDCT images and decided if further diagnostic cardiac catheterization was necessary. The accuracy of MDCT in detecting separate cardiovascular anomalies and bolus geometry of contrast enhancement were calculated. RESULTS: A total of 14 neonates were included in the study. No further diagnostic cardiac catheterization was needed in any neonate. The accuracy of MDCT in diagnosing separate cardiovascular anomalies was 98% (53/54) with only one atrial septal defect missed in a patient with coarctation syndrome. The average cardiovascular enhancement in evaluated chambers was 471 HU. No obvious beam-hardening artefact was observed. CONCLUSION: The technical and clinical feasibility of MDCT in complex congenital heart disease in neonates is confirmed. After initial assessment with echocardiography, MDCT could probably replace diagnostic cardiac catheterization for further anatomical clarification in neonates.
