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Published on: June 21, 2016
Serial changes in anatomy and ventricular function on dual-source cardiac computed tomography after the Norwood
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. ghw68@hanmail.net.
Insights
Dual-source cardiac CT effectively tracks anatomical and functional changes after the Norwood procedure for hypoplastic left heart syndrome, revealing RV dysfunction and pulmonary artery changes over time.
Area of Science:
- Cardiovascular Imaging
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Accurate assessment of anatomy and ventricular function post-Norwood procedure for hypoplastic left heart syndrome is crucial.
- Echocardiography and cardiac MRI have limitations in evaluating these changes.
Purpose of the Study:
- To assess serial changes in cardiac anatomy and ventricular function using dual-source cardiac CT.
- To evaluate patients after the Norwood procedure for hypoplastic left heart syndrome.
Main Methods:
- Dual-source cardiac CT performed pre-procedure, early post-procedure (1 month), and late post-procedure (4.5 months).
- Evaluated ventricular function, pulmonary artery size, right ventricular free wall thickness, and ascending aorta size.
- Assessed morphological features like VSD, endocardial fibroelastosis, and coronary ventricular communication.
Main Results:
- Right ventricular function initially unchanged, then decreased with increased volumes later post-procedure.
- Pulmonary artery size gradually decreased; stenoses identified in 21.4% of patients.
- Right ventricular free wall thickness increased early and decreased late; hypoplastic ascending aorta noted in 21.4%.
Conclusions:
- Dual-source cardiac CT is a viable tool for serial assessment of anatomy and ventricular function.
- Provides valuable insights into post-Norwood procedure changes in hypoplastic left heart syndrome patients.
Background:
Accurate evaluation of anatomy and ventricular function after the Norwood procedure in hypoplastic left heart syndrome is important for treatment planning and prognostication, but echocardiography and cardiac MRI have limitations.
Objective:
To assess serial changes in anatomy and ventricular function on dual-source cardiac CT after the Norwood procedure for hypoplastic left heart syndrome.
Materials And Methods:
In 14 consecutive patients with hypoplastic left heart syndrome, end-systolic and end-diastolic phase cardiac dual-source CT was performed before and early (average: 1 month) after the Norwood procedure, and repeated late (median: 4.5 months) after the Norwood procedure in six patients. Ventricular functional parameters and indexed morphological measurements including pulmonary artery size, right ventricular free wall thickness, and ascending aorta size on cardiac CT were compared between different time points. Moreover, morphological features including ventricular septal defect, endocardial fibroelastosis and coronary ventricular communication were evaluated on cardiac CT.
Results:
Right ventricular function and volumes remained unchanged (indexed end-systolic and end-diastolic volumes: 38.9±14.0 vs. 41.1±21.5 ml/m2, P=0.7 and 99.5±30.5 vs. 105.1±33.0 ml/m2, P=0.6; ejection fraction: 60.1±7.3 vs. 63.8±7.0%, P=0.1, and indexed stroke volume: 60.7±18.0 vs. 64.0±15.6 ml/m2, P=0.5) early after the Norwood procedure, but function was decreased (ejection fraction: 64.2±2.6 vs. 58.1±7.1%, P=0.01) and volume was increased (indexed end-systolic and end-diastolic volumes: 39.2±14.9 vs. 68.9±20.6 ml/m2, P<0.003 and 107.8±36.5 vs. 162.9±36.2 ml/m2, P<0.006, and indexed stroke volume: 68.6±21.7 vs. 94.0±21.3 ml/m2, P=0.02) later. Branch pulmonary artery size showed a gradual decrease without asymmetry after the Norwood procedure. Right and left pulmonary artery stenoses were identified in 21.4% (3/14) of the patients. Indexed right ventricular free wall thickness showed a significant increase early after the Norwood procedure (25.5±3.5 vs. 34.8±5.1 mm/m2, P=0.01) and then a significant decrease late after the Norwood procedure (34.8±5.1 vs. 27.2±4.2 mm/m2, P<0.0001). The hypoplastic ascending aorta smaller than 2 mm in diameter was identified in 21.4% (3/14) of the patients. Ventricular septal defect (n=3), endocardial fibroelastosis (n=2) and coronary ventricular communication (n=1) were detected on cardiac CT.
Conclusion:
Cardiac CT can be used to assess serial changes in anatomy and ventricular function after the Norwood procedure in patients with hypoplastic left heart syndrome.
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