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Tytuł pozycji:

Optimized Computed Tomography Angiography Protocol for the Evaluation of Thrombus in Patients with Fontan Anatomy.

Tytuł :
Optimized Computed Tomography Angiography Protocol for the Evaluation of Thrombus in Patients with Fontan Anatomy.
Autorzy :
Boggs R; Department of Pediatrics, Congenital Heart Center, University of Florida, 1600 SW Archer Road, PO BOX 100297, Gainesville, FL, 32610, USA. .
Dibert T; Department of Pediatrics, Congenital Heart Center, University of Florida, 1600 SW Archer Road, PO BOX 100297, Gainesville, FL, 32610, USA.
Co-Vu J; Department of Pediatrics, Congenital Heart Center, University of Florida, 1600 SW Archer Road, PO BOX 100297, Gainesville, FL, 32610, USA.
DeGroff C; Department of Pediatrics, Congenital Heart Center, University of Florida, 1600 SW Archer Road, PO BOX 100297, Gainesville, FL, 32610, USA.
Quinn N; Department of Radiology, University of Florida, Gainesville, FL, USA.
Chandran A; Department of Pediatrics, Congenital Heart Center, University of Florida, 1600 SW Archer Road, PO BOX 100297, Gainesville, FL, 32610, USA.
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Źródło :
Pediatric cardiology [Pediatr Cardiol] 2020 Dec; Vol. 41 (8), pp. 1601-1607. Date of Electronic Publication: 2020 Aug 12.
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Publication: New York Ny : Springer Verlag
Original Publication: [New York, Springer-Verlag]
MeSH Terms :
Computed Tomography Angiography/*methods
Fontan Procedure/*adverse effects
Heart Defects, Congenital/*surgery
Thrombosis/*diagnostic imaging
Angiography/methods ; Female ; Fontan Procedure/methods ; Heart Defects, Congenital/diagnostic imaging ; Heart Ventricles/abnormalities ; Heart Ventricles/surgery ; Humans ; Male ; Retrospective Studies ; Thromboembolism/diagnostic imaging ; Thromboembolism/epidemiology ; Thrombosis/etiology ; Tomography, X-Ray Computed/methods
References :
Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia. Thorax 26(3):240–248. (PMID: 10.1136/thx.26.3.240)
Puga FJ, Chiavarelli M, Hagler DJ (1987) Modifications of the Fontan operation applicable to patients with left atrioventricular valve atresia or single atrioventricular valve. Circulation 76(3):53–60.
DeLeval MR, Kilner P, Gewillig M, Bull C (1988) Total cavopulmonary connection: a logical alternative to atriopulmonary connections for complex Fontan operations. J Thorac Cardiovasc Surg 96:682–695. (PMID: 10.1016/S0022-5223(19)35174-8)
Jonas RA, Castaneda AR (1988) Modified Fontan procedure: atrial baffle and systemic venous to pulmonary artery anastomotic techniques. J Card Surg 3(2):91–96. (PMID: 10.1111/j.1540-8191.1988.tb00228.x)
Laschinger JC, Ringel RE, Brenner JI, McLaughlin JS (1992) Extracardiac total cavopulmonary connection. Ann Thorac Surg 54(2):371–373. (PMID: 10.1016/0003-4975(92)91407-Z)
de Leval MR, Dubini G, Migliavacca F (1996) Use of computational fluid dynamics in the design of surgical procedures: application to the study of competitive flows in cavo-pulmonary connections. J Thorac Cardiovasc Surg 111:502–513. (PMID: 10.1016/S0022-5223(96)70302-1)
DeGroff CG (2008) Modeling the Fontan circulation: where we are and where we need to go. Pediatr Cardiol 29:3–12. (PMID: 10.1007/s00246-007-9104-0)
Coon PD, Rychik J, Novello RT, Ro PS, Gaynor JW, Spray TL (2001) Thrombus formation after the Fontan operation. Ann Thorac Surg 71(6):1990–1994. (PMID: 10.1016/S0003-4975(01)02472-9)
Jacobs ML (2005) The Fontan operation, thromboembolism, and anticoagulation: a reappraisal of the single bullet theory. J Thorac Cardiovasc Surg 129(3):491–495. (PMID: 10.1016/j.jtcvs.2004.09.017)
Allen K, Downing TE, Glatz AC, Rogers LS, Ravishankar C, Rychik J, Fuller S, Montenegro LM, Steven JM, Spray TL, Nicolson SC, Gaynor JW, Goldberg DJ (2017) Effect of Fontan-associated morbidities on survival with intact Fontan circulation. Am J Cardiol 119(11):1866–1871. (PMID: 10.1016/j.amjcard.2017.03.004)
Khairy P, Fernandes SM, Mayer JE Jr, Triedman JK, Walsh EP, Lock JE, Landzberg MJ (2008) Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation 117(1):85–92. (PMID: 10.1161/CIRCULATIONAHA.107.738559)
Alsaied T, Bokma JP, Engel ME, Kuijpers JM, Hanke SP, Zuhlke L, Zhang B, Veldtman GR (2017) Factors associated with long-term mortality after Fontan procedures: a systematic review. Heart 103(2):104–110. (PMID: 10.1136/heartjnl-2016-310108)
Goldberg DJ, Dodds K, Rychlik J (2010) Rare problems associated with the Fontan circulation. Cardiol Young 20(3):113–119. (PMID: 10.1017/S1047951110001162)
Tomkiewicz-Pajak L, Hoffman P, Trojnarska O, Lipczyńska M, Podolec P, Undas A (2014) Abnormalities in blood coagulation, fibrinolysis, and platelet activation in adult patients after the Fontan procedure. J Thorac Cardiovasc Surg 147:1284–1290. (PMID: 10.1016/j.jtcvs.2013.06.011)
Sandler KL, Markham LW, Mah ML, Byrum EP, Williams JR (2014) Optimizing CT angiography in patients with Fontan physiology: single-center experience of dual-site power injection. Clin Radiol 69(12):562–567. (PMID: 10.1016/j.crad.2014.09.011)
Mahani M, Agarwal P, Rigsby C, Lu J, Dehkordy S, Wright R, Dorfman A, Krishnamurthy R (2016) CT for assessment of thrombosis and pulmonary embolism in multiple stages of single-ventricle palliation: challenges and suggested protocols. Radiographics 36(5):1273–1284. (PMID: 10.1148/rg.2016150233)
Contributed Indexing :
Keywords: Computed tomography angiography; Congenital heart disease; Fontan; Pulmonary embolus; Thromboembolic disease
Entry Date(s) :
Date Created: 20200814 Date Completed: 20201214 Latest Revision: 20201215
Update Code :
20201231
DOI :
10.1007/s00246-020-02417-9
PMID :
32785745
Czasopismo naukowe
The Fontan procedure is the final stage in the palliative surgical approach to patients with single-ventricle physiology. These patients have an increased risk for thromboembolic disease in the Fontan circuit, which can be evaluated by chest computed tomography angiography (CTA) in acute settings. However, false-positive results are common secondary to unusual streaming patterns in the Fontan circuit. A biphasic CTA protocol was evaluated for the capability to clearly identify structures of the Fontan circuit that are critical for the evaluation of thromboembolic disease. The study was a retrospective chart review of Fontan patients with a chest CTA scan obtained between 2011 and 2017. Two pediatric cardiologists with additional training in cardiac CT imaging independently reviewed each CTA and awarded one point for each of 5 Fontan circuit structures clearly identified resulting in a score range of 0-5. A score of 0-2 considered not capable, 3-4 partially capable, and 5 capable to clearly identify critical structures of the Fontan circuit. During the study period, 46 CTA scans were performed on 21 patients. Of the CTA scans using a biphasic protocol, 62.5% (10/16) were considered capable to clearly identify all 5 critical structures of the Fontan circuit vs 27% (8/30) of the CTA scans using a monophasic protocol (p = 0.027). Overall our results suggest that the single-site biphasic CTA protocol has greater diagnostic capability to detect the presence of Fontan thromboembolic disease when compared to the more traditional monophasic CTA protocol. Future prospective studies are needed to confirm these findings.

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