CT for Assessment of Thrombosis and Pulmonary Embolism in Multiple Stages of Single-Ventricle Palliation: Challenges and Suggested Protocols.
The total cavopulmonary connection (TCPC), or Fontan procedure, diverts systemic venous blood directly into the pulmonary arteries and is the palliative surgery of choice for patients with a wide variety of congenital heart diseases with single-ventricle physiologic characteristics. Pulmonary embolism and thrombosis are known complications and are among the major causes of morbidity and mortality in patients after TCPC. Magnetic resonance (MR) imaging is usually performed for postoperative evaluation of patients after single-ventricle repair; however, screening for thrombosis or embolism with MR imaging is not always feasible because of the emergent nature of the clinical presentation or because of artifacts from metallic devices or coils. Computed tomographic (CT) angiography is an effective method for diagnosing pulmonary embolism in children. However, because of altered hemodynamics after single-ventricle palliation, there are unique challenges in achieving optimal opacification of the pulmonary arteries and Fontan circuit that can result in nondiagnostic CT angiographic studies or erroneous image interpretation. Radiologists should be familiar with the multiple stages of single-ventricle palliation, understand the technique for performing pulmonary CT angiography at each stage, and recognize common pitfalls in obtaining and interpreting pulmonary CT angiographic images in patients who have undergone single-ventricle repair. Online supplemental material is available for this article. (©)RSNA, 2016.
From the Departments of Radiology (M.G.M., S.F.D., R.A.W.) and Pediatrics, Division of Pediatric Cardiology (J.C.L., A.L.D.), C.S. Mott Children's Hospital, 1540 E Hospital Dr, SPC 4252, Ann Arbor, MI 48109-4252; University of Michigan Health Center, Ann Arbor, Mich (P.P.A.); Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill (C.K.R.); and Texas Children's Hospital, Baylor College of Medicine, Houston, Tex (R.K.).
Maryam
M
Ghadimi Mahani
From the Departments of Radiology (M.G.M., S.F.D., R.A.W.) and Pediatrics, Division of Pediatric Cardiology (J.C.L., A.L.D.), C.S. Mott Children's Hospital, 1540 E Hospital Dr, SPC 4252, Ann Arbor, MI 48109-4252; University of Michigan Health Center, Ann Arbor, Mich (P.P.A.); Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill (C.K.R.); and Texas Children's Hospital, Baylor College of Medicine, Houston, Tex (R.K.).
Prachi P
PP
Agarwal
From the Departments of Radiology (M.G.M., S.F.D., R.A.W.) and Pediatrics, Division of Pediatric Cardiology (J.C.L., A.L.D.), C.S. Mott Children's Hospital, 1540 E Hospital Dr, SPC 4252, Ann Arbor, MI 48109-4252; University of Michigan Health Center, Ann Arbor, Mich (P.P.A.); Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill (C.K.R.); and Texas Children's Hospital, Baylor College of Medicine, Houston, Tex (R.K.).
Cynthia K
CK
Rigsby
From the Departments of Radiology (M.G.M., S.F.D., R.A.W.) and Pediatrics, Division of Pediatric Cardiology (J.C.L., A.L.D.), C.S. Mott Children's Hospital, 1540 E Hospital Dr, SPC 4252, Ann Arbor, MI 48109-4252; University of Michigan Health Center, Ann Arbor, Mich (P.P.A.); Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill (C.K.R.); and Texas Children's Hospital, Baylor College of Medicine, Houston, Tex (R.K.).
Jimmy C
JC
Lu
From the Departments of Radiology (M.G.M., S.F.D., R.A.W.) and Pediatrics, Division of Pediatric Cardiology (J.C.L., A.L.D.), C.S. Mott Children's Hospital, 1540 E Hospital Dr, SPC 4252, Ann Arbor, MI 48109-4252; University of Michigan Health Center, Ann Arbor, Mich (P.P.A.); Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill (C.K.R.); and Texas Children's Hospital, Baylor College of Medicine, Houston, Tex (R.K.).
Soudabeh
S
Fazeli Dehkordy
From the Departments of Radiology (M.G.M., S.F.D., R.A.W.) and Pediatrics, Division of Pediatric Cardiology (J.C.L., A.L.D.), C.S. Mott Children's Hospital, 1540 E Hospital Dr, SPC 4252, Ann Arbor, MI 48109-4252; University of Michigan Health Center, Ann Arbor, Mich (P.P.A.); Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill (C.K.R.); and Texas Children's Hospital, Baylor College of Medicine, Houston, Tex (R.K.).
Robyn A
RA
Wright
From the Departments of Radiology (M.G.M., S.F.D., R.A.W.) and Pediatrics, Division of Pediatric Cardiology (J.C.L., A.L.D.), C.S. Mott Children's Hospital, 1540 E Hospital Dr, SPC 4252, Ann Arbor, MI 48109-4252; University of Michigan Health Center, Ann Arbor, Mich (P.P.A.); Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill (C.K.R.); and Texas Children's Hospital, Baylor College of Medicine, Houston, Tex (R.K.).
Adam L
AL
Dorfman
From the Departments of Radiology (M.G.M., S.F.D., R.A.W.) and Pediatrics, Division of Pediatric Cardiology (J.C.L., A.L.D.), C.S. Mott Children's Hospital, 1540 E Hospital Dr, SPC 4252, Ann Arbor, MI 48109-4252; University of Michigan Health Center, Ann Arbor, Mich (P.P.A.); Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill (C.K.R.); and Texas Children's Hospital, Baylor College of Medicine, Houston, Tex (R.K.).
Rajesh
R
Krishnamurthy
D000072226:Computed Tomography Angiography; D018729:Fontan Procedure; D006801:Humans; D010166:Palliative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D013927:Thrombosis / Q000000981:diagnostic imaging*