Quantitative analysis of pulmonary artery and pulmonary collaterals in preoperative patients with pulmonary artery atresia using dual-source computed tomography

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Abstract

Objective

To evaluate the value of dual-source computed tomography (DSCT) in quantitatively measuring pulmonary arteries and major aortopulmonary collateral vessels in comparison with conventional angiographic (CA) on preoperative patients with pulmonary artery atresia and ventricular septal defect (PAA-VSD).

Materials and methods

Twenty PAA-VSD patients who had complete imaging data of DSCT, CA and echocardiography (ECHO) studies were retrospectively analyzed. Using final clinical diagnosis as the standard, results of DSCT, CA and ECHO on the detection of cardiac malformations, measurement of diameters of pulmonary artery and collateral vessel, as well as the values of McGoon ratio, pulmonary arterial index (PAI) and total neopulmonary arterial index (TNPAI) were derived and compared.

Results

In 20 patients, 51 of 54 (94.4%) cardiac malformations were visualized by DSCT, whereas 42 (77.8%) by ECHO (p = 0.027). Fourteen cases with aortopulmonary collateral vessels were all (100%) detected by DSCT, whereas 5 cases (35.7%) by ECHO (p = 0.001), and 13 cases (92.9%) by CA (p = 0.995). Sixteen cases with confluence of native pulmonary arteries were diagnosed by DSCT, whereas 10 cases by CA (p = 0.024). Measurement of the diameters of pulmonary arteries, collateral vessels, and descending aorta at the level of diaphragm were correlated well between DSCT and CA (r = 0.95–0.99). McGoon ratio (DSCT = 1.18 ± 0.60, CA = 1.23 ± 0.64), PAI (DSCT = 130.96 ± 99.38 mm2/m2, CA = 140.91 ± 107.87 mm2/m2) and TNPAI (DSCT = 160.31 ± 125.62 mm2/m2, CA = 169.14 ± 122.81 mm2/m2) were calculated respectively, without significant differences between DSCT and CA by paired t-tests (all p > 0.05).

Conclusion

DSCT was efficient for evaluating and measuring native pulmonary artery and aortopulmonary collateral vessels prior to surgical procedures in PAA-VSD patients. Combined with echocardiography, DSCT showed potential to replace CA for evaluating pulmonary artery atresia noninvasively.

Section snippets

Patient population

Twenty PAA-VSD patients who had complete preoperative data of DSCT, echocardiography (ECHO) and CA were retrospectively analyzed in this study. Informed consent forms of DSCT and CA examinations were signed. In enrolled patients, there were 13 male and 7 female patients with age range from 43 days to 22 years old. In 20 patients, 10 patients were less than 5 years old (average height = 78.30 ± 16.90 cm; average weight = 9.53 ± 3.10 kg; body surface area = 0.45 ± 0.14 m2), 8 patients were 10–18 years old

Results

The final clinical diagnoses showed a total of 54 cardiac malformations in these 20 patients. As shown in Table 1, the echocardiography showed higher diagnostic rate of ASD than CTA and CA, but the difference was not statistically significant (χ2 = 1.06, p = 0.588). For overall cardiac malformations, the diagnostic rate was 94.4% (51/54) on DSCT, 85.2% on CA (p = 0.790 in comparison with DSCT), and 77.8% on echocardiography (p = 0.027 in comparison with DSCT), respectively.

The diagnostic rate of the

Discussion

Pulmonary artery atresia (PAA) with ventricular septal defect (VSD) is a rare congenital heart disease. The major pathological feature is no connection between right ventricle and pulmonary artery, and the pulmonary blood supply comes from systemic circulation. Ideally, earlier surgical repair will improve patient life quality and decrease death rate [1]. The electron beam CT and multi-slice spiral CT showed promising usefulness in depicting pre- and post-operative morphological changes in

Conflict of interest statement

None declared.

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The research was granted by the Youth Research Project of Fu Jian province, China (No. 2009-2-8).

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