Dual-Axis Rotational Angiography is Safe and Feasible to Detect Coronary Allograft Vasculopathy in Pediatric Heart
Rodrigo Rios1, Rohit S Loomba2, Susan R Foerster2
1Division of Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, 9000 Wisconsin Avenue, Milwaukee, WI, 53226, USA. rrios@chw.org.
Insights
Dual-axis rotational angiography (RA) is a safe and effective method for screening coronary allograft vasculopathy (CAV) in pediatric heart transplant recipients. This technique provides multi-plane imaging, potentially reducing radiation and contrast exposure in young patients.
Area of Science:
- Cardiology
- Pediatric Transplantation
- Medical Imaging
Background:
- Coronary allograft vasculopathy (CAV) is a primary cause of graft failure and mortality in pediatric heart transplant recipients.
- Conventional angiography is standard for CAV screening, but dual-axis rotational angiography (RA) may offer benefits like reduced radiation and contrast use.
- Limited pediatric experience exists for RA in CAV screening.
Purpose of the Study:
- To evaluate the safety and feasibility of dual-axis rotational angiography (RA) for screening coronary allograft vasculopathy (CAV) in pediatric heart transplant recipients.
- To assess procedural outcomes, including radiation dose, contrast volume, and imaging success rates, of RA in this population.
Main Methods:
- A retrospective review of a single institution's catheterization database identified pediatric heart transplant recipients who underwent RA for CAV screening.
- Procedural data, including radiation dose (dose-area product, air kerma), fluoroscopy time, contrast volume, procedure time, imaging success, and ECG changes, were collected.
- Data were analyzed to assess the safety, feasibility, and effectiveness of RA in this cohort.
Main Results:
- Ninety-seven patients underwent 345 RA procedures.
- Median radiation dose-area product per kilogram was 341.7 mGy cm(2)/kg, total air kerma was 126.8 mGy, and contrast volume was 13 ml.
- RA was successful in imaging 98% of coronary artery injections, with only 3% of procedures showing ECG changes. CAV was detected in 14 patients.
Conclusions:
- Dual-axis rotational angiography (RA) is a safe and feasible imaging modality for screening coronary allograft vasculopathy (CAV) in pediatric heart transplant recipients.
- RA offers the advantage of multi-plane coronary imaging compared to conventional angiography.
- The technique demonstrates acceptable radiation doses and contrast volumes in this pediatric population.
Abstract:
Coronary allograft vasculopathy (CAV) is the leading cause of graft failure in pediatric heart transplant recipients, also adding to mortality in this patient population. Coronary angiography is routinely performed to screen for CAV, with conventional single-plane or bi-plane angiography being utilized. Dual-axis rotational coronary angiography (RA) has been described, mostly in the adult population, and may offer reduction in radiation dose and contrast volume. Experience with this in the pediatric population is limited. This study describes a single-institution experience with RA for screening for CAV in pediatric patients. The catheterization database at our institution was used to identify pediatric heart transplant recipients having undergone RA to screen for CAV. Procedural data including radiation dose, fluoroscopy time, contrast volume, and procedure time were collected for each catheterization. The number of instances in which RA was not successful, ECG changes were present, and CAV was detected were also collected for each catheterization. A total of 97 patients underwent 345 catheterizations utilizing RA. Median radiation dose-area product per kilogram was found to be 341.7 (mGy cm(2)/kg), total air kerma was 126.8 (mGy), procedure time was 69 min, fluoroscopy time was 9.9 min, and contrast volume was 13 ml. A total of 17 (2 %) coronary artery injections out of 690 could not be successfully imaged using RA. A total of 14 patients had CAV noted at any point, 10 of whom had progressive CAV. Electrocardiographic changes were documented in a total of 10 (3 %) RA catheterizations. Procedural characteristics did not differ between serial catheterizations. RA is safe and feasible for CAV screening in pediatric heart transplant recipients while offering coronary imaging in multiple planes compared to conventional angiography.
