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Three-Dimensional Rotational Angiography in the Assessment of Vascular and Airway Compression in Children After a Cavopulmonary Anastomosis

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Abstract

The aim of the study was to examine the role of three-dimensional rotational angiography (3DRA) in assessing vascular and airway narrowing in children with a bidirectional cavopulmonary anastomosis (BCPA). The course of children with single ventricle physiology is often complicated by left pulmonary artery (LPA) and/or bronchial stenosis and may be related to aortic compression. 3DRA may be useful in evaluating this complex anatomy and possible mechanisms for the observed obstruction. Clinical data and imaging (2D angiography and 3DRA) of children with a BCPA were reviewed retrospectively. Measurements were taken at similar locations along the pulmonary arteries in both modalities and in the airways on 3DRA. Twenty-five children with a previous BCPA were assessed at mean age of 3.1 ± 2.0 years and weight of 13.6 ± 3.6 kg. Excellent correlation was found between 3DRA and 2D angiographic LPA measurements (r = 0.89, p < 0.0001). Twelve children had qualitative LPA stenosis on 3DRA, with a stenotic dimension of 6.6 ± 2.2 mm on 2D angiography and 6.8 ± 1.9 mm on 3DRA (r = 0.94, p < 0.0001). Ten cases with LPA stenosis also had bronchial stenosis (83 %). Qualitative airway assessment correlated with quantitative bronchial dimensions from 3DRA-derived tomographic images: Bronchial stenosis measured 4.4 ± 1.6 versus 5.9 ± 1.1 mm in those with a normal appearing bronchus (p = 0.009). Hybrid patients (initial palliation with bilateral pulmonary artery banding and arterial ductal stenting, n = 5) and all patients with a Damus–Kaye–Stansel (DKS) anastomosis (n = 9) were more likely to have LPA and left bronchial stenosis (OR 7.7, p = 0.04). 3DRA is a useful and accurate tool in assessment of LPA and airway narrowing after BCPA. Hybrid and DKS patients are more prone to LPA and bronchial stenosis, and 3DRA can provide insight into the mechanism.

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto School of Medicine, 555 University Ave, Toronto, ON, M5G 1X8, Canada

    Sharon Borik, Sabina Volodina, Rajiv Chaturvedi, Kyong Jin Lee & Lee N. Benson

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  1. Sharon Borik
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  2. Sabina Volodina
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  3. Rajiv Chaturvedi
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  4. Kyong Jin Lee
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  5. Lee N. Benson
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Correspondence to Lee N. Benson.

Electronic supplementary material

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246_2015_1130_MOESM1_ESM.mp4

Supplemental Video 1 3D rotating image of the BCPA and branch PA’s of LPA stenosis related to a dilated aorta and retained ductal stent after a hybrid procedure. (MP4 2499 kb)

246_2015_1130_MOESM2_ESM.mp4

Supplemental Video 2 3D rotating image of the BCPA, pulmonary arteries, and airway, corresponding to figure 4, showing severe bronchial stenosis related to the LPA and aorta in a Hybrid patient. Abbreviation as in fig. 1-2. (MP4 4512 kb)

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Borik, S., Volodina, S., Chaturvedi, R. et al. Three-Dimensional Rotational Angiography in the Assessment of Vascular and Airway Compression in Children After a Cavopulmonary Anastomosis. Pediatr Cardiol 36, 1083–1089 (2015). https://doi.org/10.1007/s00246-015-1130-8

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  • DOI: https://doi.org/10.1007/s00246-015-1130-8

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