Pediatric Cardiology

, Volume 34, Issue 3, pp 560–565

Dual-Axis Rotational Coronary Angiography: A New Technique for Detecting Graft Coronary Vasculopathy in Pediatric Heart Transplant Recipients

  • Todd M. Gudausky
  • Andrew N. Pelech
  • Gail Stendahl
  • Kathryn Tillman
  • Judy Mattice
  • Stuart Berger
  • Steven Zangwill
Original Article

DOI: 10.1007/s00246-012-0494-2

Cite this article as:
Gudausky, T.M., Pelech, A.N., Stendahl, G. et al. Pediatr Cardiol (2013) 34: 560. doi:10.1007/s00246-012-0494-2

Abstract

Annual surveillance coronary angiograpyhy to screen for graft coronary vasculopathy is routine practice after orthotopic heart transplantation. Traditionally, this is performed with direct coronary angiography using static single-plane or biplane angiography. Recently, technological advances have made it possible to perform dual-axis rotational coronary angiography (RA). This technique differs from standard static single-plane or biplane angiography in that a single detector is preprogrammed to swing through a complex 80° arc during a single injection. It has the advantage of providing a perspective of the vessels from a full arc of images rather than from one or two static images per contrast injection. The current study evaluated two coronary angiography techniques used consecutively at a single center to evaluate pediatric heart transplant recipients for graft coronary vasculopathy. A total of 23 patients underwent routine coronary angiography using both biplane static coronary angiography (BiP) and RA techniques at the Children’s Hospital of Wisconsin from February 2009 to September 2010. Demographic and procedure data were collected from each procedure and analyzed for significance utilizing a Wilcoxon rank sum test. No significant demographic or procedural differences between the BiP and the RA procedures were noted. Specific measures of radiation dose including fluoroscopy time and dose area product were similar among the imaging techniques. The findings show that RA can be performed safely and reproducibly in pediatric heart transplant recipients. Compared with standard BiP, RA does not increase radiation exposure or contrast use and in our experience has provided superior angiographic imaging for the evaluation of graft coronary vasculopathy.

Keywords

Coronary angiographyGraft vasculopathyHeart transplantation

Supplementary material

246_2012_494_MOESM1_ESM.avi (60 mb)
Normal left coronary artery rotational angiogram. (AVI 61444 kb)
246_2012_494_MOESM2_ESM.avi (45.8 mb)
Normal right coronary artery rotational angiogram. (AVI 46851 kb)
246_2012_494_MOESM3_ESM.avi (60 mb)
Left coronary artery rotational angiogram with severe GV. There is moderate stenosis of the proximal circumflex and anterior descending coronary arteries. There is severe narrowing of the first diagonal branch and nearly complete occlusion of the distal anterior descending coronary artery. The mid portion of the first marginal branch is 90 % occluded, and the distal circumflex artery is severely narrowed beyond the origin of the second marginal branch. Note the presence of an implantable defibrillator and the excellent visualization of all the coronary segments as the lead and device are rotated off the coronary arteries. (AVI 61444 kb)
246_2012_494_MOESM4_ESM.avi (45.8 mb)
Right coronary artery (RCA) rotational angiogram with severe GV. There is severe ostial stenosis of the RCA. The distal vessel is underfilled and appears small. The image is not centered ideally, and the distal portions of the RCA are not seen at the end of the injection. (AVI 46851 kb)

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Todd M. Gudausky
    • 1
  • Andrew N. Pelech
    • 1
  • Gail Stendahl
    • 1
  • Kathryn Tillman
    • 1
  • Judy Mattice
    • 2
  • Stuart Berger
    • 1
  • Steven Zangwill
    • 1
  1. 1.Division of Pediatric CardiologyMedical College of Wisconsin, The Herma Heart Center, Children’s Hospital of WisconsinMilwaukeeUSA
  2. 2.The Herma Heart Center, Children’s Hospital of WisconsinMilwaukeeUSA