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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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