64-slice Computed Tomography For Preoperative Diagnosis And Postoperative Evaluation Of Congenital Heart Disease

Purposeanalysing the performance of 64-slice computed tomography (64-SCT) before and after congenital heart surgery to discuss the value of 64-SCT to the preoperative diagnosis and postoperative follow-up of congenital cardiovascular by comparing with the surgical results and Transthoracic echocardiograph(TTE).Materials and methods1.Clinical dataWe collected 60 patients with congenital heart disease checked by 64-SCT in our hospital from January to december in 2008. There were 25 male and 35 female with the age from 1 to 13 (the average age is 5.8 year-old), all of them checked by the TTE before surgery, and 24 of them checked by the 64-SCT and TTE after surgery.2.Scanning technologyApplying SIEMENS Sensation 64-SCT scanner to scan the patients. Scan parameters: tube voltage 80-120KV, tube current 100-500mA, collimator 64×0.6 mm, pitch 0.9,Scan range: from the thoracic entrance to every 5cm under the left septum.We Applied dual-phase scan to check the patients, and used Ulrich medical missouri high-pressure injection to inject 0.6～2.0ml/kg non-ionic contrast agent(350mgI/ml), the amount of which must be less than the weight of the patient. And the velocity of flow is 0.5～2.0ml/s. To the patients who were willing to co-operate, we took the breath-hold scan. And to the patients who were unwilling to co-operate, we let them take chloral hydrate(0.5ml/kg) to be imperturbable, then to receive the quiet breathing scan.3.Post-processing methodsAfter scanning, we sent the scan data to Leonardo( Siemens dedicated image processing worksation), with the help of Siemens preloaded Functional CT data processing software(the version number is 2006A). The data of the patients received normal ECG-gated by 75% R-R interval, and the data of the patients did not receive ECG-gated by big vessels fast scanning mode, with the layer thickness of 0.75 mm, and the thick of the reconstruction interval of 0.3 mm. And in the sync workstation, we restructure the data by volume rendering, maximum intensity projction, multi planar reformation, shade-surface displayment and other methods.4.Image analysis and statistical processing.Two doctors with rich experience of diagnosing cardiovascular imaging analysed the images respectively. If there were differences between their diagnosis, they would review the images together to get the unified conclusion.We applied the SPSS 13.0 package to check the data by Chi-square test and T test. If the p<0.05, the differences would be considered to have statistical significance.ResultI . the preoperative evaluation of 64-SCT to congenital heart diseaseThere were totally 224 confirmed malformations in the 60 cases of patients. The diagnostic accuracy rates of 64-SCT and TTE were 95.9% and 87.1% respectively. The accuracy rates of these two diagnostic were significantly different.( x~2=7.42, P<0.01)1 .malformations in heart: there were 89 malformations confirmed by surgery, including Auricle of heart apposing, ASD, SV, ECD, VSD, SV, Tricuspid atresia, and ROVTS. The number of misdiagnosis of 64-SCT was 6, and TTE was 10. There was no significant difference in the accuracy rates of these two diagnostic. (x~2 =0.159, p>0.05)2. connecting part of a major blood vessels in heart: there were 46 malformations confirmed by surgery, including TGA, Aortic overriding, DORY, TAPVC, Anomalous vena systemica connection. The number of misdiagnosis of 64-SCT was 2, and TTE was 4. There was no significant difference in the accuracy rates of these two diagnostic.( x~2=0.05, p>0.05 )3.great vessels: there were 89 malformations confirmed by surgery, including PS, Pulmonary atresia, Anomalous origin of pulmanary, COA, IAA, Double aortic arch, TRU, APW, PDA, MAPCA. The number of misdiagnosis of 64-SCT was 4, and TTE was 22. There were significant differences in the accuracy rates of these two diagnostic.II. The postoperative evaluation of 64-SCT to congenital heart disease1.24 cases of postoperative follow-up surgery in patients with a Bank of China 12 cases, including 3 cases of TCPC, six cases of GLENN shunt, 1 cases of B-T shunt, 1 cases of center shunt, 1 1 1/2 ventricular correction.2.the remaining 12 cases, including 4 cases of TOF total correction, 1 case of RPA - PA anastomosis, 1 cases of DORV correction, two cases of COA correction, 1 case of pulmonary BJVC reconstruction, 1 case of interruption of aortic arch correction, 1 case of aortic arch surgery treatment, one cases of total anomalous pulmonary venous drainage correction.3.24 malformation patients with a total of 86 confirmed, by direct surgical correction of deformities were 29, and the remaining deformity surgery or indirect interest only treatment assessment. Direct surgical correction of this deformity in a total of 29, surgical correction of cardiac anomalies 12, after 64-SCT showed absence of AV have been closed or repaired crack, and no residual shunt, RVOT are widening. A misdiagnosis TTE will not patched have been misdiagnosed as VSD patch, and the rest after reviewing the results of TTE and 64-SCT results.Cardiovascular malformations junction a direct surgical treatment for pulmonary venous drainage, after 64-SCT and TTE have shown that pulmonary vein into the left atrium has been, without anastomotic stenosis.Large vascular malformation surgery 16 directly after 64-SC.T showed TTE examination and PDA, MAPCA have ligation. 64-SCT opponent after anastomotic patency, the artificial blood vessel location and patency can clearly show, in which one cases of 64-SCT showed IVC thrombosis see artificial lumen, TTE did not show. 1 case of aortic arch after 64-SCT showed irregular anastomotic stenosis, and can be seen not only the whole exudate, TTE did not show the rest of the main stenosis and reconstruction, have shown that pulmonary artery lumen has widened, and luminal patency.4. In this group , 64-SCT found 23 complications, TTE found 8. 64-SCT has more obvious advantages than TTE in the diagnosis of postoperative complications in congenital heart disease, especially in the diagnosis of Respiartory comlications.Reslut1. In the diagnosis of congenital cardiovascular disease, 64-SCT and TTE basically has the same accuracy rates of the diagnosis in deformities of heart and in the deformities of the connecting part of major vessels in heart, but 64-SCT is better than TTE in the deformities of the connecting part of major vessels in heart. 64-SCT can be took as an important preoperative examiantion of congenital heart disease, especially the complex malformation. 2. To the surgical site of congenital heart disease, the location and patency of vascular anastomosis, the location and luminal situation of artificial blood vessels, cardiovascular malformations and postoperative complications , 64-SCT can indicate clearly, which can help the doctor make a comprehensive asessment to the physical condition of the patient. Thus, it can be took as an important postoperative examination of congenital heart disease.