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Completion angiography after cardiac surgery for congenital heart disease: complementing the intraoperative imaging
Ralf J Holzer1, Matt Sisk, Joanne L Chisolm
1Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA. ralf.holzer@nationwidechildrens.org
Insights
Completion angiograms after congenital heart surgery can detect unexpected issues like pulmonary artery stenosis. This imaging technique aids in early diagnosis and therapy, potentially reducing the need for reintervention.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Diagnostic Imaging
Background:
- Residual structural abnormalities after congenital heart disease surgery can impact recovery.
- Intraoperative completion angiography offers a method for early detection and management of these abnormalities.
Purpose of the Study:
- To report institutional experience with completion angiograms following cardiopulmonary bypass surgery.
- To evaluate the utility of intraoperative completion angiography in identifying and guiding the treatment of postsurgical cardiac defects.
Main Methods:
- Retrospective review of 32 cardiac surgical procedures in 31 patients (median age 7.5 months) between October 2007 and August 2008.
- Completion angiograms were performed in the operating room after cardiopulmonary bypass.
- Analysis of angiographic findings, including pulmonary artery stenoses and coronary blood flow impairment, and subsequent therapeutic decisions.
Main Results:
- Unexpected pathology was identified in 56.3% of procedures, most commonly left and right pulmonary artery stenoses.
- Findings led to a change in therapeutic management in 28.1% of cases, including surgical revision, hybrid therapy, and early catheterization.
- Complications related to completion angiography were rare, occurring in only one procedure.
Conclusions:
- Intraoperative completion angiography in a Hybrid cardiac operating suite is valuable for early diagnosis and therapy of postsurgical abnormalities.
- This imaging modality complements other intraoperative techniques and may decrease the need for subsequent reinterventions.
- Completion angiography facilitates timely management decisions, improving patient outcomes after complex congenital heart surgery.
Abstract:
Residual structural pathology after cardiac surgery for congenital heart disease may complicate postoperative recovery. Completion angiograms obtained in the operating room may facilitate early detection and therapy of residual structural abnormalities. Our objective here is to report our institutional experience performing completion angiograms after cardiopulmonary bypass surgery. Between October 2007 and August 2008, 31 patients underwent completion angiograms after 32 cardiac surgical procedures. The median age was 7.5 months (range, 50 days to 31.2 years) and the median weight was 6.5 kg (range, 3.1-153 kg). Type of procedure, angiographic findings, and therapeutic decision were retrospectively reviewed. Procedures (proc) evaluated through completion angiography included comprehensive stage II or Glenn (n = 13), aortic arch reconstruction/conduit (n = 3), repair/palliation of tetralogy of Fallot or pulmonary atresia with ventricular septal defect (n = 4), PVR or conduit replacement (n = 5), and others (n = 7). Unexpected pathology was identified in 18 of 32 (56.3%) proc, which included left pulmonary artery (LPA) stenoses (n = 15), right pulmonary artery (RPA) stenoses (n = 11), and stenosis impairing coronary blood flow (after DKS; n = 1). In 9 of 32 (28.1%) proc, findings may have led to a change in therapeutic management. This included surgical revision (n = 1), 'Hybrid' therapy in the same setting (n = 2: LPA stent, 1; RPA balloon, 1), early catheterization within 3 months (n = 4), and change in medical management (n = 2: change in anticoagulation, 1; early CT, 1). Complications related to completion angiography were seen in only a single procedure (LPA staining). In conclusion, completion angiograms using a dedicated Hybrid cardiac operating suite may aid in early diagnosis and therapy of postsurgical abnormalities. They complement other methods of intraoperative imaging and may reduce the potential need for early surgical or transcatheter reintervention.
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