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How Does Cross-Sectional Imaging Impact the Management of Patients With Single Ventricle After Bidirectional
Ezequiel Sagray1, Frank Cetta1, Patrick W O'Leary1
1Department of Pediatric and Adolescent Medicine; Division of Pediatric Cardiology, 4352Mayo Clinic, Rochester, MN, USA.
Insights
Surveillance imaging like CT angiography and cardiac MRI significantly impacts clinical decisions in pediatric patients after bidirectional cavopulmonary connection (BDCPC). This is especially true for patients over one year old and those without hypoplastic left heart syndrome.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Congenital Heart Disease
Background:
- No consensus exists on surveillance cross-sectional imaging for pediatric patients post-bidirectional cavopulmonary connection (BDCPC).
- Computed tomography with angiography (CTA) and cardiac magnetic resonance (CMR) are utilized for imaging in these patients.
Purpose of the Study:
- To determine the impact of CTA and CMR imaging on the clinical management of pediatric patients following BDCPC.
- To evaluate the effectiveness of surveillance imaging in this specific patient population.
Main Methods:
- A single-center retrospective study analyzed 30 CTA/CMR studies in 24 pediatric patients with single ventricle physiology and BDCPC (2010-2019).
- Imaging studies were categorized by impact: major, minor, or none.
- Analysis considered patient age, diagnosis (e.g., hypoplastic left heart syndrome - HLHS), and study indication.
Main Results:
- Over 40% of CTA/CMR studies had a major clinical impact.
- Studies performed in patients aged ≥1 year and in non-HLHS patients showed a significantly higher major impact.
- Research CMR studies also demonstrated a notable clinical impact in some cases.
Conclusions:
- CTA/CMR imaging plays a significant role in the clinical management of pediatric patients with single ventricle after BDCPC.
- Imaging in older children (≥1 year) and those without HLHS is associated with greater clinical impact.
- Cardiac MRI warrants consideration as a potential surveillance imaging tool for this population.
Background:
There is currently no consensus regarding the use of surveillance cross-sectional imaging in pediatric patients after bidirectional cavopulmonary connection (BDCPC). We sought to determine how computed tomography with angiography (CTA) and cardiac magnetic resonance (CMR) imaging impacted the clinical management of pediatric patients after BDCPC.
Methods:
A single-center retrospective study including patients with single ventricle who had BDCPC between 2010 and 2019, and CTA/CMR studies obtained in these patients, at ≤5 years of age, and with Glenn physiology. Repeat studies on the same patient were included if the clinical situation had changed. The impact of CTA/CMR studies was categorized as major, minor, or none.
Results:
Twenty-four patients (63% male) and 30 imaging studies (22 CTAs) were included. 60% were obtained in patients with hypoplastic left heart syndrome (HLHS); most common indication was Follow-up after an intervention (23%). 6 CMRs were performed on stable HLHS patients as part of a research protocol, with no clinical concerns. The overall impact of CTA/CMR studies was major in 13 cases (43.3%). CTA/CMR studies performed ≥1 year of age (62.5% vs 21.4%, P = .02) and in non-HLHS patients (66.7% vs 27.8%, P = .035) were associated with major impact. Also, 2/6 Research studies were associated with a major impact.
Conclusions:
CTA/CMR imaging in pediatric patients with SV after BDCPC was associated with significant clinical impact in over 40% of cases, with a higher impact if obtained in patients ≥1 year of age and in non-HLHS patients. We cannot disregard the possibility of CMR as a surveillance imaging modality in this population.
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