Abstract
Cross-sectional imaging (cardiovascular MRI and CT) has become a crucial component in the diagnostic pathway in patients with congenital heart disease over the last decade. Their use compliments echocardiography and, for many cases, has superseded the use of diagnostic cardiac catheterisation. Though cardiovascular MRI is still the main form of cross-sectional imaging for CHD, increases in the speed of CT (examinations can be completed in seconds) and reductions in the radiation dose (sub-mSv radiation dose exposure) mean that cardiovascular CT is being increasingly used for the assessment of CHD, in particular in neonates and young children.
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Unrepaired tetralogy of Fallot in a neonate, contrast-enhanced CT. Axial slices through the thorax and upper abdomen, starting in the neck. (1) Left-sided aortic arch with normal branching pattern; (2) tortuous patent ductus arteriosus (PDA) from the left, inferior surface of the aortic arch passing to the mid-left pulmonary artery (LPA); (3) proximal LPA stenosis; (4) small pulmonary valve; (5) clockwise rotation of the origins of the coronary arteries; (6) right ventricular outflow tract narrowing; (7) ventricular septal defect (VSD); (8) atrial septal defect (ASD) (MOV 29372 kb)
Dynamic 3D volume-rendered reconstructions of the right ventricular outflow tract, pulmonary trunk and proximal branch pulmonary arteries, all viewed from anterior. Images from 12 patients all with an original diagnosis of tetralogy of Fallot, treated with complete repair in infancy and then imaged 15 to 20 years later. Note the wide range of anatomies and dynamic motion. Imaging useful for pulmonary valve replacement, in particular for selecting if patients are suitable for percutaneous pulmonary valve implantation (MOV 18043 kb)
Cine contrast-enhanced CT, acquired during prospective gating. 35-year-old with tetralogy of Fallot, assessment for severe pulmonary regurgitation. Right upper image—four-chamber view of the heart; left upper image, basal short-axis view; right lower image, right ventricular outflow tract view; left lower image, mid-short-axis view. Note patient not suitable for cardiac MRI as permanent pacemaker in situ—pacing wire artefact seen on all images (MOV 14060 kb)
Anomalous left coronary artery from the pulmonary artery (ALCAPA) in a 17-year-old, contrast-enhanced CT. Rotation of 3D volume-rendered image. Note large right coronary artery, with large collateral vessels that cross the right ventricular outflow tract. The left coronary artery arises from the posterior left side of the pulmonary artery (MOV 26559 kb)
Transposition of the great arteries with an atrial switch operation in a 38-year-old, contrast-enhanced CT. The right upper image (axial view) shows the origin of the left coronary artery (LCA) from the posterior aortic sinus. The LCA passes directly between the aorta and the pulmonary trunk. Right lower image shows the normal course of the right coronary artery, which arises from the anterior aortic sinus (not shown). Left image, sagittal cine of the outflow tracts (aorta anterior, pulmonary trunk posterior). Note the dynamic compression of the LCA between the two great vessels (MOV 14635 kb)
Cine sagittal image of the right ventricular outflow tract (RVOT) in a 12-year-old, contrast-enhanced CT. The patient had been previously treated with a pulmonary artery stent and percutaneous pulmonary valve implantation. Encroachment of the stents into the dynamic RVOT had caused stent fracture and dynamic RVOT obstruction (MOV 8373 kb)
Dynamic 3D volume-rendered reconstruction of the right ventricular outflow tract, pulmonary trunk and proximal branch pulmonary arteries, viewed from anterior. The cine image shows the first-in-man implantation of the Medtronic Harmony(TM) Transcatheter Pulmonary Valve (MOV 11953 kb)
Stented aortic coarctation in a 25-year-old, contrast-enhanced CT. 3D volume-rendered image that has then been rotated to show the narrowing of the coarctation stent, the relationship of the stent to the origin of the left subclavian artery and a small pseudoaneurysm at the distal end of the stent. These images were used to plan for the insertion of a covered stent to cover the mouth of the pseudoaneurysm and relieve the re-coarctation whilst ensuring that the origin of the left subclavian artery was not covered (MOV 20004 kb)
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Taylor, A. (2019). CT in Congenital Heart Disease Diagnosis and Transcatheter Treatment. In: Butera, G., Chessa, M., Eicken, A., Thomson, J.D. (eds) Atlas of Cardiac Catheterization for Congenital Heart Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-72443-0_40
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DOI: https://doi.org/10.1007/978-3-319-72443-0_40
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