Imaging characteristics and associations in twisted atrioventricular connections on multidetector computed tomography
Mumun Sinha1, Niraj Nirmal Pandey1, Arun Sharma1
1Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
Insights
Multidetector computed tomography angiography (CTA) effectively diagnoses twisted atrioventricular connections in congenital heart disease. CTA accurately identifies cardiac arrangements and associated anomalies, aiding in diagnosis and management.
Area of Science:
- Cardiology
- Radiology
- Pediatric Cardiology
Background:
- Twisted atrioventricular connections are complex congenital heart defects.
- Accurate diagnosis is crucial for appropriate management and surgical planning.
Purpose of the Study:
- To evaluate the imaging characteristics of twisted atrioventricular connections using multidetector computed tomography (CT) angiography.
- To identify associated intra- and extracardiac anomalies in these patients.
Main Methods:
- Retrospective review of 2605 CT angiography studies for suspected congenital heart disease.
- Diagnosis of twisted atrioventricular connections in 12 patients.
- Application of the segmental sequential approach and determination of ventricular topology.
- Assessment for associated anomalies.
Main Results:
- Twelve patients diagnosed with twisted atrioventricular connections.
- Varied viscero-atrial arrangements (usual, mirror-imaged), ventricular topologies, and ventriculoarterial connections observed.
- Associated anomalies included septal defects, pulmonic stenosis, and valve abnormalities.
- No coronary anomalies were identified.
Conclusions:
- CT angiography is a valuable tool for diagnosing twisted atrioventricular connections.
- CTA enables precise identification of cardiac spatial arrangements and associated anomalies.
- This imaging modality aids in comprehensive assessment of complex congenital heart disease.
Aim:
To evaluate the imaging characteristics and associations in patients with twisted atrioventricular connections on multidetector computed tomography (CT) angiography.
Material And Methods:
We retrospectively reviewed 2605 CT angiography studies performed for suspected congenital heart diseases in our institution from January 2014 to December 2018. Twisted atrioventricular connections were diagnosed in 12 patients. Segmental sequential approach developed by Anderson et al was employed to characterize the complex congenital heart disease. Ventricular topology was also determined. CTA was also assessed to look for any associated intra- and extracardiac anomalies.
Results:
Out of 12 patients with twisted atrioventricular connections, usual viscero-atrial arrangement was seen in nine patients, two patients had mirror-imaged viscero-atrial arrangement and one patient had mirror-imaged atrial arrangement. Right-sided heart was seen in four patients. Two patients had discordant atrioventricular connections, seven had concordant atrioventricular connections while three showed double-inlet right ventricle. Ventriculoarterial connections were concordant in two patients, discordant in one patient while nine patients had double-outlet right ventricle. Superior-inferior ventricular morphology with near-horizontal interventricular septum was seen in four patients. Left-sided aortic arch with normal branching pattern was observed in nine patients. No coronary anomaly was seen in any patient. Other associations included ventricular and atrial septal defects, pulmonic stenosis, hypoplasia/atresia of tricuspid valve, straddling of mitral valve, and duplicated superior caval veins.
Conclusion:
CT angiography is useful in diagnosis of twisted atrioventricular connections with accurate identification of viscero-atrial arrangement, atrioventricular and ventriculoarterial connections, and orientation and presence or absence of associated anomalies.
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