A Cinical Study On Complex Congenital Heart Disease Using 64-slice Spiral Computer Tomography Angiography

Objective:The aim of study was to approach scan type,images'post processing mode and diagnostic program of 64-slice spiral computer tomography in the detection of complex congenital heart disease(CCHD), approaching the value of multi-slice spiral computer tomography angiography (MSCTA) in the detection of deformities in patienmts with complex congenital heart disease (CCHD). and to compare the consequence with gold standard (operation treat or digital subtraction angiography (DSA) consequence),MSCTA and echocardiography(Echo),Method:MSCTA and echocardiography were performed in 26 patients (males 12, females 14, mean age 17.125 years old, meta-age 14 years old, oldest 55 years old, youngest 54 days)with known complex congenital heart disease, to compare the consequence with gold standard (operation or DSA) and echocardiography. All MSCTA raw images were reconstructed with multiple planar reconstruction (MPR),maximum intensity projection (MIP), surface shaded display(SSD) and volume rendering (VR). Statistics of consequence were done by SPSS 13. Every patient were dedvided into two groups(the group of Echo and the group of MSCTA) on the diagnosis of intracardiac or extracardiac malformation, a evaluation of diagnostic test(sensitivity and omission diagnose rate),and sensitivity'chi square test, consistency check were done between the two group, P<0.05 were statistical significance. Every patient were dedvided into three groups(the group of Echo,the group of MSCTA and the group of MSCTA+Echo) on the diagnosis of CCHD, a evaluation of diagnostic test(sensitivity and omission diagnose rate),and sensitivity'chi square test, consistency check were done within the three group, P<0.05 were statistical significance. Result:There were 34 kinds of cardiovascular malformations,8 kinds of intracardiac malformation, including Ventricualr Septal Defect (VSD;n=16), Atrial Septal Defect (ASD;n=6), Pulmonic Valve Atresia (PVA; n=1),Acleistocardia (n=1),Single Atrium (n=1),Atrio-rentriculor Valve Backstreaming (n =5), Pulmonic Valvular Stenosis (PVS; n=1), Backstreaming of Aortic Valve (n=3).26 kinds of extracardiac malformation, including Outlet Right Ventricle (n=2), Pulmonary Artery Stenosis (PAS; n=9), Widen of Pulmonary Artery(n=10), Aortic Overriding (n=6), Interruption of Aortic Arch (n=1), Underdevelopment of Aortic Arch (n=2), Coarctation of Aorta (COA; n=1), Persistent Truncus Arteriosus (PTA; n=2), Patent Ductus Arteriosus (PDA;n=7), Abnormal Anatomy of Coronary Artery (n=3), Double Superior Vena Cava (n=3), Anomalous of Left Subclavian vein Connection (n=1), Right Sided Aortic Arch (n=5), Aortectasia(n=5), Pulmonary Artery Straddle(n=1), Souble Blood Supply of Pulmonary Artery (n=1), Double Blood Supply of Hilum of Right Lung (n=1), Increment of Cor Dextrum (n=16), Total Anomalous of Pulmonary Venous Connection (TAPVD; n=2), Increment of Cor Sinistrum (n=10), Broaden of Right Coronary Sinus (n=1), Anomalous Origin of Pulmonary Artery(n=1), Complete Transposition of Great Arteries (n=4), Endomembrane Avulsion of Aorta Ascendens (n=1), Corrected Transposition of Great Arteries (n=1), Anomalous of Coronary Vein Connection (n=1). The total of 131 anomalies was diagnosed, including 34 intracardiac and 97 extracardiac malformation. The diagnosis sensitivity on intracardiac malformation of MSCTA,Echo were 67.65%(23/34),97.06 %(33/34)((X2=10.12, P=0.001<0.05), with their omission diagnose rate were 32.35%(11/34),2.94%(1/34). The diagnosis sensitivity on extracardiac malformation of MSCTA,Echo were 93.81%(91/97),67.01%(65/97)(X2=22.12, P<0.000<0.05), with their omission diagnose rate were 6.19%(6/97),32.99%(32/97). The diagnosis sensitivity on CCHD of MSCTA,Echo,MSCTA+Echo were 87.02%(114/131),74.81%(98/131),94.66%(124/131)(X2=21.18, P<0.0001<0.05), with their omission diagnose rate were 12.98%(17/131),25.19% (33/131),5.34%(7/131). Conclusion:Morphological alteration of complex congenital heart disease could be estimated by MSCTA. It could exactly appraise of great vessels' anatomic form,disposed relation,dissection anomalism of coronary artery,dimensional position relation of collateral circulation exceptionally MSCTA and Echo may become an altenrative method in the detection of complex congenital heart disease. The combination of both is helpful to provide a final diagnosis and also to improve the treatment management of that. Some common complication and preoperative information,such as origin and anatomic form of great vessels,distribution of abnormal collateral circulation, could be exactly displayed with three-dimensional reconstruction image, it make for preoperative operation plan and tracing,curative evaluation of postoperative patients.