title: Selective use of cardiac computed tomography angiography: an alternative diagnostic modality before second-stage single ventricle palliation.
abstract: OBJECTIVE
  To assess the accuracy and risk of substituting cardiac computed tomography for cardiac catheterization in select patients for evaluation of anatomy before second-stage single ventricle palliation.
  
  
  METHODS
  This is a retrospective review of consecutive diagnostic cardiac catheterization (n=16) and computed tomography studies (n=16) performed before second-stage single ventricle palliation from March 2010 to July 2012 at a single institution. Risk (anesthesia, vascular access, contrast, and radiation exposure), accuracy, and postoperative course were compared. Nonparametric analysis was used to compare differences in group medians.
  
  
  RESULTS
  General anesthesia was used for 16 of 16 cardiac catheterization studies and 1 of 16 computed tomography studies. Vascular access was central venous and/or arterial for all cardiac catheterization studies and a peripheral intravenous line for all computed tomography studies. Median age- and size-adjusted radiation dose was 14.0 mSv for cardiac catheterization and 1.1 mSv for computed tomography. Contrast dose was 4.8 mL/kg for the cardiac catheterization group and 2 mL/kg for the computed tomography group. There were no computed tomography discrepancies and 1 discrepancy between cardiac catheterization and surgical findings. There were 8 adverse events in 6 patients in the cardiac catheterization group and 1 adverse event in the computed tomography group. There was no difference between groups in postoperative course or need for repeat intervention.
  
  
  CONCLUSIONS
  Cardiac computed tomography and cardiac catheterization are equally accurate for evaluation of anatomy before second-stage single ventricle palliation when compared with surgical findings. Computed tomography may be the preferred test in select patients because of decreased vascular access and anesthesia risk, lower radiation and contrast exposure, and fewer adverse events.
authors.affiliation: Advanced Cardiac Imaging, Minneapolis Heart Institute and Foundation, Minneapolis, Minn; Division of Cardiology and Cardiothoracic Surgery, Children's Heart Clinic, Minneapolis, Minn; Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn. Electronic address: khan@chc-pa.org.
authors.forename: B Kelly
authors.initials: BK
authors.lastname: Han
authors.affiliation: Division of Cardiology and Cardiothoracic Surgery, Children's Heart Clinic, Minneapolis, Minn.
authors.forename: Marko
authors.initials: M
authors.lastname: Vezmar
authors.affiliation: Advanced Cardiac Imaging, Minneapolis Heart Institute and Foundation, Minneapolis, Minn.
authors.forename: John R
authors.initials: JR
authors.lastname: Lesser
authors.affiliation: Siemens Medical Solutions, Malvern, Penn.
authors.forename: Gregory
authors.initials: G
authors.lastname: Michalak
authors.affiliation: Siemens Medical Solutions, Malvern, Penn.
authors.forename: Katharine
authors.initials: K
authors.lastname: Grant
authors.affiliation: Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn.
authors.forename: David
authors.initials: D
authors.lastname: Dassenko
authors.affiliation: Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn.
authors.forename: Jill
authors.initials: J
authors.lastname: Maresh
authors.affiliation: Division of Cardiology and Cardiothoracic Surgery, Children's Heart Clinic, Minneapolis, Minn; Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn.
authors.forename: David M
authors.initials: DM
authors.lastname: Overman
mesh_terms: D006328:Cardiac Catheterization; D003287:Contrast Media; D017023:Coronary Angiography; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care; D011829:Radiation Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media