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Digital subtraction angiography in the diagnosis of vascular rings
Insights
Digital subtraction angiography (DSA) accurately diagnosed vascular rings in pediatric patients. Intravenous DSA is a safe and effective alternative to arterial catheterization for diagnosing these complex congenital heart anomalies.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Diagnostic Imaging
Background:
- Vascular rings are congenital anomalies that can cause significant morbidity in infants and children.
- Accurate diagnosis is crucial for timely intervention and management.
- Conventional angiography is invasive and carries risks.
Purpose of the Study:
- To evaluate the utility of digital subtraction angiography (DSA) in diagnosing vascular rings.
- To compare intravenous DSA with arterial catheterization for vascular ring diagnosis.
- To assess the safety and accuracy of DSA in a pediatric population.
Main Methods:
- Six patients suspected of having a vascular ring underwent DSA.
- Five patients received intravenous contrast, and one patient underwent arterial catheterization.
- Esophagrams were reviewed for associated abnormalities.
Main Results:
- DSA accurately defined the anatomy in all patients.
- Vascular rings were confirmed in three patients, with variations including right aortic arch and mirror-image branching.
- Two patients were found to have an anomalous right subclavian artery, excluding a vascular ring.
- Intravenous DSA demonstrated no complications and provided accurate anatomical definition.
Conclusions:
- Digital subtraction angiography is a valuable adjunctive diagnostic tool for suspected vascular rings.
- Intravenous DSA can obviate the need for more invasive arterial catheterization.
- DSA offers accurate anatomical definition with a favorable safety profile in pediatric patients.
Abstract:
Digital subtraction angiography was performed in six patients suspected of having a vascular ring. There were four males and two females. Two patients were less than 6 months of age, two were between 14 and 20 months, and two were ages 4 and 53 years. Four of the six patients had abnormal esophagrams. Five patients underwent peripheral intravenous digital subtraction angiography and a sixth patient underwent digital subtraction angiography via arterial catheterization. In two patients (ages 20 months and 4 years), the presence of a vascular ring was excluded by demonstrating an anatomically normal arch with an anomalous right subclavian artery. In three patients, a right aortic arch was present. Two of these patients had mirror image branching and a left ligamentum arteriosum. The third patient had an aberrant left subclavian artery and a left ligamentum. One patient had an anomalous right subclavian artery and a systemic collateral vessel arising from the aorta, supplying a confluence of vessels in the right lung hilum. In all patients, anatomic definition was accurate with the intravenous injection and there were no complications. In the patient who underwent intra-arterial injection, the dose of contrast was reduced 50% from the dose usually administered. Digital subtraction angiography appears to be a good adjunctive diagnostic method in patients in whom the presence of a vascular ring needs to be confirmed angiographically and obviates the need for arterial catheterization.