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Three-Dimensional Rotational Angiography during Catheterization of Congenital Heart Disease - A ten Years' experience
Stefanie Söder1, Wolfgang Wällisch1, Sven Dittrich1
1Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany.
Insights
Three-dimensional rotational angiography (3DRA) is a valuable tool for diagnosing and treating congenital heart disease (CHD). While effective, its current use in pediatric cardiology is limited, with benefits not yet outweighing the effort.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatric Cardiology
Background:
- Congenital heart disease (CHD) management requires advanced imaging techniques.
- Three-dimensional rotational angiography (3DRA) offers detailed anatomical visualization.
- Current application of 3DRA in CHD is not standardized or widespread.
Purpose of the Study:
- To evaluate the usability and benefits of 3DRA in patients with CHD.
- To assess 3DRA's role in the cardiac catheterization lab.
- To analyze radiation exposure, contrast dye usage, diagnostic utility, and image quality of 3DRA in CHD.
Main Methods:
- Retrospective analysis of 872 3DRA procedures in CHD patients (January 2010 - May 2019).
- Evaluation of radiation dose (DAP), contrast volume, diagnostic utility, and image quality.
- Comparison of 3D-model utility against native 3D angiography.
Main Results:
- 3DRA was utilized in 67.1% for interventions and 32.9% for diagnostics.
- Median DAP was 54.1 µGym², with 1.6 ml/kg contrast dye used.
- The 3D-model from 3DRA was superior to native 3D angiography in 94% of cases.
Conclusions:
- 3DRA is an effective diagnostic and interventional tool for CHD.
- Widespread adoption in pediatric cardiology is hindered by an imbalance between effort and benefit.
- Future advancements in less invasive techniques may enhance 3DRA's utility.
Abstract:
This paper aims to assess the usability and advantages of three-dimensional rotational angiography (3DRA) in patients with congenital heart disease (CHD) and its application in the cath lab. Up to now, its use in CHD is not widespread or standardized. We analyzed all patients with CHD who underwent a 3DRA at our facility between January 2010 and May 2019. The 3DRAs were evaluated for radiation exposure, contrast dye consumption, diagnostic utility and image quality. We performed 872 3DRAs. 3DRA was used in 67.1% of the cases for interventional procedures and in 32.9% for diagnostic purposes. Two different acquisition programs were applied. The median dose-area product (DAP) for all 872 rotations was 54.1 µGym2 (21.7-147.5 µGym2) and 1.6 ml/kg (0.9-2.07 ml/kg) of contrast dye was used. Diagnostic utility of the generated 3D-model was rated superior to the native 3D angiography in 94% (819/872). 3DRA is an excellent and save diagnostic and interventional tool. However, 3DRA has not become a standard imaging procedure in pediatric cardiology up to now. Effort and advantage seems to be unbalanced, but new less invasive techniques may upgrade this method in future.
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