Pre-Glenn CT: how I do it

Cardiac computed tomography angiography (CTA) provides high-resolution imaging of cardiac and vascular structures. Improvements in temporal and spatial resolution, combined with radiation dose reduction and rapid image acquisition, have led to wide adoption of this technology in patients with congenital heart disease of all ages and heart rates. Patients with single ventricle heart disease are a complex patient population with variable underlying anatomy. Typically, a stepwise approach of three palliative interventions is performed, culminating in the Fontan procedure to separate the systemic venous and the systemic arterial circulation. Echocardiography is insufficient to define thoracic vasculature, and invasive or non-invasive angiography is standard of care prior to second stage palliation. Cardiac CT prior to second stage superior-cavopulmonary anastomosis (Glenn) provides complete definition of thoracic vascular and cardiac anatomy with low comprehensive diagnostic risk compared to alternate modalities. Cardiac CTA is increasingly used to help guide the appropriate surgical or percutaneous intervention for second stage palliation. An approach to cardiac CTA for pre-Glenn evaluation including scan planning, image acquisition, and reporting will be described.