MDCT for Complex Congenital Heart Disease

Dr. Muhammad Ayub, FCPSDiplomate Certification Board of Nuclear Cardiology

Diplomate Board of Cardiovascular Computed Tomography

Department of Cardiovascular ImagingPunjab Institute of Cardiology Lahore

Assessment of congenital heart disease is a challenge for any diagnostic modality.

Introduction

Echocardiography stays as a very useful tool for initial diagnosis◦ Provides excellent information about intra-

cardiac anatomy◦ Provides Hemodynamic information

Limitations:◦ Difficulty in delineating extra-cardiac vessels is

entirety Limited Windows Inability to penetrate bone and air

Echocardiography

Gold standard for◦ Hemodynamic data.◦ Defining anatomy of accessible chambers and

vessels. Limitations

◦ Invasive◦ Inability to assess vessels beyond high grade

stenosis and atresia.◦ Limited planes and lack of 3D information.

Cardiac Catheterization for Congenital Heart Disease

The advent of MDCT has stimulated many for its use in congenital heart disease patients owing to its capability of 3D anatomy and non invasive nature of the test.

Cardiac MDCT for Congenital Heart Disease

Cardiac CT for Complex Congenital Heart Disease +

◦ Noninvasive◦ High spatial

resolution.◦ Fast◦ 3D Data◦ Global Assessment

of Cardiac and Extra Cardiac Structures

-◦ Radiation Exposure◦ Requirement for

contrast.◦ Gating and motion

artifacts◦ No Hemodynamic

information

ACCF/ACR/SCCT/SCMR/ASNC/NASCI /SCAI/SIR Appropriateness Criteria for Cardiac Computed

Tomography and Cardiac Magnetic Resonance Imaging

Appropriate Indication for Cardiac CT

Structure and Function—Morphology (Use of CT Angiogram)

● Assessment of complex congenital heart disease including anomalies of coronary circulation, great vessels, and cardiac chambers and valves A(7)

SV ASD + PAPVD

Appropriateness CriteriaAssessment of Complex Congenital Heart Disease including anomalies of coronaries, great vessels,

cardiac chambers and Valves A(7)

Anomalous Pulmonary venous Drainage

Supra-cardiac Infra-Cardiac

Truncus Arteriosus

Truncus Arteriosus

PDA

Aortic Interruption

CCTGA

PA to LA Fistula

Aorto-Pulmonary Window

Ebstein Anomaly

systolecine

Pulmonary AVM

TOF with BT and Central Shunts

Single Coronary Artery in a Patient with TGA

Double Aortic Arch in an infant with dysphagia

A 2 year old baby with ALCAPA Syndrome post CABG

Cardiac MDCT is an excellent tool for assessment of complex congenital heart disease including anomalies of coronary circulation, great vessels, and cardiac chambers and valves

Summary

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