Evaluation of ventricular septal defects using high pitch computed tomography angiography of the chest in children with complex congenital heart defects below one year of age.

Nau, David; Wuest, Wolfgang; Rompel, Oliver; Hammon, Matthias; Gloeckler, Martin; Toka, Okan; Dittrich, Sven; Rueffer, André; Cesnjevar, Robert; Lell, Michael M; Uder, Michael; May, Matthias S (2019). Evaluation of ventricular septal defects using high pitch computed tomography angiography of the chest in children with complex congenital heart defects below one year of age. Journal of cardiovascular computed tomography, 13(4), pp. 226-233. Elsevier 10.1016/j.jcct.2019.01.023

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BACKGROUND

Aim of this study was to assess the accuracy of ventricular septal defects (VSD) using high pitch computed tomography angiography (CTA) of the chest in children below 1 year of age, compared to the intraoperative findings and echocardiography.

METHODS

Out of 154 patients that underwent Dual-Source CTA of the chest using a high-pitch protocol at low tube voltages (70-80 kV), 55 underwent surgical repair of a VSD (median age 8 days, range 1-348 days). The margins of the VSDs and their relation to the surrounding structures were reproduced by en-face views using multiplanar reformations (MPR). Absolute diameter, normalized area and relative area compared to the aortic valve annulus were used for discrimination between restrictive and non-restrictive defects. Localization was classified into four subtypes. The results were compared to two-dimensional echocardiography and intraoperative findings.

RESULTS

Median absolute size of VSDs did not differ significantly between CTA-measurements (10.8 mm, range 2.8-18.1 mm) and intraoperative findings (12.0 mm, 3.0-25.0 mm, p = 0.09). Echocardiographic values were significantly lower (9.6 mm, 3.0-18.5 mm, both p < 0.01). The classification of the location and orientation matched the intraoperative situs in 96.4% of all cases using CT and in 87.3% using echocardiography. Echocardiography missed the relation to valves in 11% of all cases. Pre-interventional sensitivity and specificity for detection of a VSD were 97.2/98.9% compared to echocardiography. Median radiation dose was 0.32 mSv (range 0.12-2.00 mSv) and differed significantly between second and third generation Dual-Source CT (0.43 vs. 0.22 mSv, p = 0.003).

CONCLUSION

Size and subtype of VSDs can be accurately assessed by CTA of the chest in patients with complex congenital heart defects at a very low radiation dose.

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