Abstract
Right ventricle-pulmonary artery (RV-PA) conduits are used in the treatment of certain congenital heart disease (CHD). RV-PA conduit complications might develop over time and require intervention. To evaluate how well cardiac computed tomographic angiography (CCTA) performs compared to transthoracic echocardiography (TTE) in evaluating RV-PA conduit complications by using surgical findings as the reference standard. A retrospective chart review of all patients over a 5-year period who underwent CCTA for RV-PA conduit evaluation was performed. Patient demographics and clinical data were recorded. Preoperative CCTA and TTE findings were compared to the operative findings for concordance or discordance. Forty-one patients were included, 51% females. The complications were conduit stenosis (28.68%), infection (7.17%) and aneurysm/pseudoaneurysm (6.15%). TTE and CCTA were consistently able to visualize focal conduit stenosis (96%). The greatest discrepancy between TTE and CCTA was in evaluating for aneurysm/pseudoaneurysm, where TTE detected only 2/6 (33%) compared to CCTA which detected 6/6 (100%) of the cases. However, TTE was slightly better at detecting conduit infection (3/7, 43%) compared to CCTA (2/7, 29%). Note that 5 out of 7 patients with endocarditis had bovine jugular graft. CCTA and TTE provide similar diagnostic accuracy evaluating certain types of RV-PA conduit complications. However, certain complications were only visualized on CCTA or TTE making both modalities complementary to each other during diagnostic evaluation.
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References
Chung R, Taylor AM (2014) Imaging for preintervention planning: transcatheter pulmonary valve therapy. Circ Cardiovasc Imaging 7(1):182–189. https://doi.org/10.1161/CIRCIMAGING.113.000826
Pluchinotta FR, Bussadori C, Butera G et al (2016) Treatment of right ventricular outflow tract dysfunction: a multimodality approach. Eur Heart J Suppl J Eur Soc Cardiol 18(Suppl E):E22–E26. https://doi.org/10.1093/eurheartj/suw019
Breymann T, Thies WR, Boethig D, Goerg R, Blanz U, Koerfer R (2002) Bovine valved venous xenografts for RVOT reconstruction: results after 71 implantations. Eur J Cardiothorac Surg Off J Eur Assoc Cardiothorac Surg 21(4):703–710. https://doi.org/10.1016/s1010-7940(02)00049-0
Chen H, Shi G, Qiu L, Wang S, Chen H, Xu Z (2019) Outcomes of prosthetic valved conduits for right ventricular outflow tract reconstruction. Pediatr Cardiol 40(4):848–856. https://doi.org/10.1007/s00246-019-02081-8
Saremi F, Ho SY, Cabrera JA, Sánchez-Quintana D (2013) Right ventricular outflow tract imaging with CT and MRI: part 1, morphology. AJR Am J Roentgenol 200(1):W39–W50. https://doi.org/10.2214/AJR.12.9333
Alsoufi B (2016) Right ventricle-to-pulmonary artery conduits: do we really have an option? J Thorac Cardiovasc Surg 151(2):442–443. https://doi.org/10.1016/j.jtcvs.2015.10.100
Mery CM, Guzmán-Pruneda FA, De León LE et al (2016) Risk factors for development of endocarditis and reintervention in patients undergoing right ventricle to pulmonary artery valved conduit placement. J Thorac Cardiovasc Surg 151(2):432–441. https://doi.org/10.1016/j.jtcvs.2015.10.069. (e4412)
Poynter JA, Eghtesady P, McCrindle BW et al (2013) Association of pulmonary conduit type and size with durability in infants and young children. Ann Thorac Surg 96(5):1695–1702. https://doi.org/10.1016/j.athoracsur.2013.05.074
Karamlou T, Blackstone EH, Hawkins JA et al (2006) Can pulmonary conduit dysfunction and failure be reduced in infants and children less than age 2 years at initial implantation? J Thorac Cardiovasc Surg 132(4):829–838. https://doi.org/10.1016/j.jtcvs.2006.06.034
Mohammadi S, Belli E, Martinovic I et al (2005) Surgery for right ventricle to pulmonary artery conduit obstruction: risk factors for further reoperation. Eur J Cardiothorac Surg 28(2):217–222. https://doi.org/10.1016/j.ejcts.2005.04.014
Dearani JA, Danielson GK, Puga FJ et al (2003) Late follow-up of 1095 patients undergoing operation for complex congenital heart disease utilizing pulmonary ventricle to pulmonary artery conduits. Ann Thorac Surg 75(2):399–411. https://doi.org/10.1016/s0003-4975(02)04547-2
Caldarone CA, McCrindle BW, Van Arsdell GS et al (2000) Independent factors associated with longevity of prosthetic pulmonary valves and valved conduits. J Thorac Cardiovasc Surg 120(6):1022–1031. https://doi.org/10.1067/mtc.2000.110684
Stammnitz C, Huscher D, Bauer UMM et al (2022) Nationwide registry-based analysis of infective endocarditis risk after pulmonary valve replacement. J Am Heart Assoc 11(5):e022231. https://doi.org/10.1161/JAHA.121.022231
Saeedan MB, Wang TKM, Cremer P et al (2021) Role of cardiac CT in infective endocarditis: current evidence, opportunities, and challenges. Radiol Cardiothorac Imaging 3(1):e200378. https://doi.org/10.1148/ryct.2021200378
Sahewalla R, Ross RD, Delius RE, Halas R, Anne P (2018) Large pseudoaneurysm following right ventricle to pulmonary artery homograft placement in an infant. Ann Pediatr Cardiol 11(1):106–108. https://doi.org/10.4103/apc.APC_61_17
Sykes MC, Nathan M, Sanders SP, Gauvreau K, Pigula FA, Rhodes J (2017) Pseudoaneurysm complicating right ventricle-to-pulmonary artery conduit surgery: incidence and risk factors. J Thorac Cardiovasc Surg 154(6):2046–2049. https://doi.org/10.1016/j.jtcvs.2017.08.014
Tomar M, Bhan A (2018) Rapidly progressing giant aneurysm of right ventricular outflow tract with severe conduit obstruction: report of two cases. Images Paediatr Cardiol 20(1):1–7
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All authors contributed to the study conception and design. Both authors (RS and TH) contributed equally to this paper as first author. Material preparation, data collection and analysis were performed by RS and TH. The first draft of the manuscript was written by RS and TH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Salman, R., Huynh, T.L., More, S.R. et al. Cardiac Computed Tomographic Angiography Evaluation of Right Ventricle-Pulmonary Artery Conduits with Surgical Correlation. Pediatr Cardiol 44, 1566–1572 (2023). https://doi.org/10.1007/s00246-023-03208-8
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DOI: https://doi.org/10.1007/s00246-023-03208-8