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[Detection and quantification of left-to-right intracardiac shunts by angiocardioscintigraphy]
Insights
Angioscintigraphy reliably detects left-to-right shunts in pediatric cardiology patients, offering a non-invasive alternative to cardiac catheterization for assessing pulmonary/systemic output (QP/QS) ratios.
Area of Science:
- Pediatric Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Left-to-right shunts are common congenital heart defects requiring accurate assessment.
- Traditional methods like cardiac catheterization are invasive and carry risks.
- Non-invasive diagnostic tools are crucial for pediatric cardiac evaluation.
Purpose of the Study:
- To evaluate the reliability of angioscintigraphy for measuring the pulmonary/systemic output (QP/QS) ratio.
- To compare angioscintigraphy results with cardiac catheterization data in pediatric patients.
- To assess the utility of angioscintigraphy in detecting and quantifying left-to-right shunts.
Main Methods:
- Seventy pediatric patients (1-22 years) with suspected left-to-right shunts underwent angioscintigraphy to determine QP/QS.
- Fifty-nine patients also underwent cardiac catheterization for QP/QS measurement via oxymetry.
- Correlation analysis was performed between the two methods across different types of shunts.
Main Results:
- A strong correlation (R=0.83, p<0.001) was found between QP/QS values obtained by angioscintigraphy and oxymetry.
- High correlations were observed for atrial septal defects (R=0.85), ventricular septal defects (R=0.75), and other shunts (R=0.79).
- Angioscintigraphy detected no significant shunts in 16 patients where oxymetry also showed no significant shunt (QP/QS ≤ 1.2).
Conclusions:
- Angioscintigraphy is a reliable, non-invasive method for assessing left-to-right shunts in pediatric cardiology.
- This technique can accurately measure the pulmonary/systemic output (QP/QS) ratio, comparable to cardiac catheterization.
- In select cases, angioscintigraphy may obviate the need for invasive cardiac catheterization, reducing patient risk and healthcare costs.
Abstract:
The ratio of pulmonary/systemic output (QP/QS) was measured by angioscintigraphy in 70 patients from 1 to 22 years of age (average 10 years) admitted to the Department of pediatric cardiology for a left-to-right shunt. Fifty nine of these patients underwent cardiac cathetarisation and QP/QS determination by oxymetry. The correlation between the values of QP/QS calculated by the two techniques was R = 0,83 (p less than 0,001: n = 59); in 28 cases of atrial septal defect R = 0,85; in 20 cases of ventricular septal defect, R = 0,75; in 11 cases of other left-to-right shunts, R = 0,79. No significant shunt was detected in 16 patients by oxymetry and the QP/QS ratio on angioscintigraphy was less than or equal to 1,2 except in 3 cases. In 7 cases of isolated pulmonary stenosis and 4 cases of operated septal defects no shunt could be detected by isotopic investigation. We conclude that angioscintigraphy is a reliable non-invasive method of detection and assessment of left-to-right shunts. In some cases it may avoid the necessity of cardiac catheterisation. The advantages, limitations and applications of this method are discussed.