Three-Dimensional Rotational Angiography during Catheterization of Congenital Heart Disease – A ten Years’ experience at a single center

Söder S, Wällisch W, Dittrich S, Cesnjevar R, Pfammatter JP, Glöckler M.
Sci Rep. 2020 Apr 24;10(1):6973. doi: 10.1038/s41598-020-63903-x.
PMID: 32332807 Free PMC Article
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Abstract

This paper aims to assess the usability and advantages of three-dimensional rotational angiography (3DRA) in patients with congenital heart disease (CHD) and its application in the cath lab. Up to now, its use in CHD is not widespread or standardized. We analyzed all patients with CHD who underwent a 3DRA at our facility between January 2010 and May 2019. The 3DRAs were evaluated for radiation exposure, contrast dye consumption, diagnostic utility and image quality. We performed 872 3DRAs. 3DRA was used in 67.1% of the cases for interventional procedures and in 32.9% for diagnostic purposes. Two different acquisition programs were applied. The median dose-area product (DAP) for all 872 rotations was 54.1 µGym2 (21.7-147.5 µGym2) and 1.6 ml/kg (0.9-2.07 ml/kg) of contrast dye was used. Diagnostic utility of the generated 3D-model was rated superior to the native 3D angiography in 94% (819/872). 3DRA is an excellent and save diagnostic and interventional tool. However, 3DRA has not become a standard imaging procedure in pediatric cardiology up to now. Effort and advantage seems to be unbalanced, but new less invasive techniques may upgrade this method in future.

 

Figure 1 The figure shows the number of all catheterizations and percentage of 3DRAs overall and in interventional procedures in our institution between January 2010 and May 2019. Additionally, the number of all 3D-overlay-procedures, either 3DRA-based or by 2D-3D-registration with models from MRI or CT. The drop of 3DRA in 2014 was caused by an introduction of a new 3D-guidance technique that is based on MRI and CT-datasets.

Figure 2 Rotational angiography in the right ventricle in a 3-month-old boy with Hypoplastic left heart syndrome. Overlay in volume rendering format on the fluoroscopic image for 3D guidance. The 3D model may obstruct tiny structures like wires and devices.

Figure 3 3D-guidance for stenting the arterial duct in a newborn with Hypoplastic left heart syndrome. Basic dataset was a 3rd generation dual source –CT, reconstructed in stereolithographic format. Overlay on both cameras of the biplan angiography machine, shown is the image of the b-camera. The fine delineated model does not obstruct the view on catheters and devices. Color-code light green: ductus arteriosus; red: aorta; violet: right ventricle; light blue: pulmonary artery.

Figure 4 Adult patient with coarctation of the aorta; overlay of a 3D angiography produced by MRI. It is reconstructed in stereolithographic format. 3D-guidance is used for stenting the coarctation.

 

source:https://pubmed.ncbi.nlm.nih.gov/32332807/

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