Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-05-31T10:30:24.600Z Has data issue: false hasContentIssue false
  • English
  • Français

Pre-procedural CT imaging aids neonatal PDA stenting for ductal-dependent pulmonary blood flow with reduction in overall procedural morbidity

Part of: Advanced Imaging

Published online by Cambridge University Press:  19 October 2021

Yousef Arar Open the ORCID record for Yousef Arar [Opens in a new window] ,
V. Vivian Dimas ,
Alan W. Nugent ,
Tarique Hussain ,
Nima Kasraie ,
Surendranath R. Veeram Reddy Open the ORCID record for Surendranath R. Veeram Reddy [Opens in a new window] ,
Thomas M. Zellers  and
Carrie Herbert
Yousef Arar*
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
V. Vivian Dimas
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
Alan W. Nugent
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
Tarique Hussain
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
Nima Kasraie
Affiliation:
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Surendranath R. Veeram Reddy
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
Thomas M. Zellers
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
Carrie Herbert
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
*
Author for correspondence: Y. Arar, Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235-7701, USA. Tel: +214 456 7311; Fax: +214 456 6154. E-mail: Yousef.Arar@UTSouthwestern.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Patent ductus arteriosus stenting for ductal-dependent pulmonary blood flow is a technically challenging neonatal procedure to maintain a stable pulmonary circulation. Pre-procedural computed tomography imaging aids in outlining ductal origin, insertion, size, course and curvature. Computed tomography imaging may add value to procedural outcomes and reduce overall procedural morbidity in neonatal patent ductus arteriosus stenting. We conducted a single centre retrospective chart review of neonates with ductal-dependent pulmonary blood flow who underwent patent ductus arteriosus stenting between January 1, 2014 and June 31, 2020. We compared patients variables between patients who underwent pre-procedural computed tomography imaging to those who did not. A total of 64 patients were referred for patent ductus arteriosus stenting with 33 (52%) obtaining pre-procedural computed tomography imaging. Average age [19 days; range 1–242 days (p = 0.85)] and weight [3.3 kg (range 2.2–6.0 kg; p = 0.19)] was not significantly different between the groups. A diagnosis of pulmonary atresia was made in 42 out of 64 (66%) patients prior to patent ductus arteriosus stenting. The cohort with pre-intervention computed tomography imaging had a significant reduction in the total number of access sites (1.2 versus 1.5; p = 0.03), contrast needed (5.9 versus 8.2 ml/kg; p = 0.008), fluoroscopy (20.7 versus 38.8 minutes; p = 0.02) and procedural time (83.4–128.4 minutes; p = 0.002) for the intervention. There was no significant difference in radiation burden between the groups (p = 0.35). Pre-procedural computed tomography imaging adds value by aiding interventional planning for neonatal patent ductus arteriosus stenting. A statistically significant reduction in the number of access sites, contrast exposure, as well as fluoroscopic and procedural time was noted without significantly increasing the cumulative radiation burden.

Keywords

Congenital heart Diseasepaediatric catheterisation/interventionadvanced imagingcardiac CT
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 9 , September 2022 , pp. 1401 - 1406
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gibbs, JL, Rothman, MT, Rees, MR, Parsons, JM, Blackburn, ME, Ruiz, CE. Stenting of the arterial duct: a new approach to palliation for pulmonary atresia. Br Heart J 1992; 67: 240–245.CrossRefGoogle ScholarPubMed
Chamberlain, RC, Ezekian, JE, Sturgeon, GM, Barker, PCA, Hill, KD, Fleming, GA. Preprocedural three-dimensional planning aids in transcatheter ductal stent placement: a single-center experience. Catheter Cardiovasc Interv 2020; 95(6): 1141–1148. DOI 10.1002/ccd.28669.CrossRefGoogle ScholarPubMed
Qureshi, AM, Goldstein, BH, Glatz, AC, et al. Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting. Catheter Cardiovasc Interv 2019; 93(5): 933–943. DOI 10.1002/ccd.28125. Epub 2019 Feb 21.CrossRefGoogle ScholarPubMed
Aggarwal, V, Petit, CJ, Glatz, AC, Goldstein, BH, Qureshi, AM. Stenting of the ductus arteriosus for ductal-dependent pulmonary blood flow—current techniques and procedural considerations. Congenit Heart Dis 2019; 14: 110–115. DOI 10.1111/chd.12709.CrossRefGoogle ScholarPubMed
Romanyukha, A, Folio, L, Lamart, S, Simon, SL, Lee, C. Body size-specific effective dose conversion coefficients for CT scans. Radiat Prot Dosimetry 2016; 172: 428–437. DOI 10.1093/rpd/ncv511.CrossRefGoogle ScholarPubMed
Deak, PD, Smal, Y, Kalender, WA. Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 2010; 257: 158–166. DOI 10.1148/radiol.10100047.CrossRefGoogle ScholarPubMed
Schauer, DA, Linton, OW. NCRP Report No. 160, Ionizing Radiation Exposure of the Population of the United States, medical exposure--are we doing less with more, and is there a role for health physicists? Health Phys 2009; 97: 1–5. DOI 10.1097/01.HP.0000356672.44380.b7.CrossRefGoogle Scholar
Trattner, S, Halliburton, S, Thompson, CM, et al. Cardiac-specific conversion factors to estimate radiation effective dose from dose-length product in computed tomography. JACC Cardiovasc Imaging 2018; 11: 64–74. DOI 10.1016/j.jcmg.2017.06.006.CrossRefGoogle ScholarPubMed
Nicholson, GT, Glatz, AC, Qureshi, AM, et al. Impact of palliation strategy on interstage feeding and somatic growth for infants with ductal-dependent pulmonary blood flow: results from the congenital catheterization research collaborative. J Am Heart Assoc 2020; 9: e013807. DOI 10.1161/JAHA.119.013807.CrossRefGoogle ScholarPubMed
Glatz, AC, Petit, CJ, Goldstein, BH, et al. A comparison between pat- ent ductus arteriosus stent and modified Blalock-Taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow: insights from the congenital catheterization research collaborative. Circulation 2018; 137: 581–588.CrossRefGoogle Scholar
Bentham, JR, Zava, NK, Harrison, WJ, et al. Duct stenting versus modified Blalock Taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter national study. Circulation 2018; 137: 589–601.CrossRefGoogle Scholar
Roggen, M, Cools, B, Brown, S, et al. Can ductus arteriosus morphology influence technique/outcome of stent treatment? Catheter Cardiovasc Interv 2020; 95: 1149–1157. DOI 10.1002/ccd.28725.CrossRefGoogle ScholarPubMed
Jadhav, SP, Aggarwal, V, Madand, PM, Diaz, E, Zhang, W, Qureshi, AM. Correlation of ductus arteriosus length and morphology between computed tomographic angiography and catheter angiography and their relation to ductal stent length. Pediatr Radiol 2020; 50: 800–809. DOI 10.1007/s00247-020-04624-1.CrossRefGoogle ScholarPubMed
Arar, Y, Reddy, SRV, Kim, H, et al. 3D advanced imaging overlay with rapid registration in CHD to reduce radiation and assist cardiac catheterisation interventions. Cardiol Young 2020; 30(5): 656–662. DOI 10.1017/S1047951120000712. Epub 2020 Apr 15.CrossRefGoogle ScholarPubMed