Effectiveness of Three-dimensional Cardiac Computed Tomography Scan in Congenital Heart Surgery-An Impact on Diagnostic Performance and Surgical Management.

Abstract

Background: Recent advances in gated cardiac contrast-enhanced computed tomography (CECT) with anesthesia support, enhance the imaging performance in congenital heart disease (CHD). 3D reconstruction of the CECT image is a novel modality that could help manage pediatric cardiac patients.

Methods: A retrospective study of children diagnosed with CHD presenting for surgical intervention (n = 139) was carried out at our cardiac surgical center. Primary diagnosis was established by transthoracic echocardiography. Analysis of all data and reports including echocardiography, cardiac CECT, operative notes, and medical documents were performed to determine the impact of cardiac 3D CECT concerning the following: supporting the primary diagnosis, providing relevant diagnostic information, prompting management changes, cardiac catheterization or interventions.

Results: Forty-eight children underwent cardiac CECT scans and 3D reconstruction of the images over one year. The indications of 3D CECT included suspicion of extracardiac shunt, delineation of vascular anatomy, and intracardiac structure extent identification. With cardiac 3D CECT, every patient's primary diagnostic question was answered with ease. Moreover, the accuracy of the diagnosis gave increased confidence among surgeons in the procedures they performed. 3D Cardiac CECT brought a change in the surgical management in 35.4% of scans, there was percutaneous intervention in 12.55% and surgery was abandoned and changed to medical management in 48%.

Conclusions: For children reported with complex CHD, it was evident that cardiac 3D CECT in selected patients was accurate, supported the primary diagnostic questions in almost all cases, and aided in optimization that further had an impact on surgical intervention and management.