title: Non-sedated, free breathing cardiac CT for evaluation of complex congenital heart disease in neonates.
abstract: BACKGROUND
  Neonates with complex congenital heart disease (CHD) are at risk of adverse events from anesthesia. CT angiography (CTA) performed free breathing and without sedation has not been reported for evaluation of complex CHD in neonates.
  
  
  OBJECTIVE
  The aim was to evaluate the image quality and risk of free breathing, non-sedated cardiac CTA for definition of CHD in the neonatal period and to determine accuracy compared with interventional findings.
  
  
  METHODS
  This is a combined retrospective-prospective single institution review of all non-sedated, free breathing cardiac CT angiograms performed in patients <1 month of age with complex CHD. Diagnosis, scan acquisition parameters, image quality (1- to 4-point scale), adverse events, radiation dose estimates, and accuracy compared with operative and interventional catheterization findings were recorded. Results are reported as median and interquartile range.
  
  
  RESULTS
  Nineteen non-sedated, free breathing, neonatal cardiac CT angiograms were performed during the time of review. All studies were diagnostic with a mean image quality score of 1.1 ± 0.3. Median total procedural dose-length product was 11 (range, 10-14), CT dose index volume was 0.47 (range, 0.31-0.5). Median unadjusted radiation dose was 0.15 mSv (range, 0.14-0.2 mSv), age- and size-adjusted radiation dose was 0.86 mSv (range, 0.78-1.1 mSv). No adverse events and no discrepancies compared with surgical or catheterization findings were found in the 17 of 19 patients that had subsequent intervention.
  
  
  CONCLUSIONS
  Cardiac CTA can be performed in the neonatal period free breathing and without sedation. Image quality is excellent, and there is high accuracy compared with surgical and catheterization findings at the time of intervention.
authors: The Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota, 2530 Chicago Ave South, Suite 500, Minneapolis, MN 55404, USA; The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA. Electronic address: khan@chc-pa.org.
authors: B Kelly
authors: BK
authors: Han
authors: The Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota, 2530 Chicago Ave South, Suite 500, Minneapolis, MN 55404, USA.
authors: David M
authors: DM
authors: Overman
authors: Siemens Healthcare.
authors: Katharine
authors: K
authors: Grant
authors: The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA.
authors: Kristi
authors: K
authors: Rosenthal
authors: The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA.
authors: Stephanie
authors: S
authors: Rutten-Ramos
authors: The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA.
authors: David
authors: D
authors: Cook
authors: The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA.
authors: John R
authors: JR
authors: Lesser
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D006993:Hypnotics and Sedatives; D007231:Infant, Newborn; D008297:Male; D015203:Reproducibility of Results; D015656:Respiratory Mechanics; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D006993:Hypnotics and Sedatives
keywords: Anesthesia; Cardiac CT; Congenital heart disease; Free breathing; Neonatal; Non-sedated