Research articlePreoperative evaluation of anomalous pulmonary venous connection using dual-source computed tomography: Comparison with echocardiography
Introduction
Anomalous pulmonary venous connection (APVC) is a rare congenital heart disease, in which pulmonary veins drain into a systemic vein or the right atrium rather than into the left atrium. Anatomical presentations may vary from mild single partial anomalous pulmonary venous connection (PAPVC) to severe obstructed total anomalous pulmonary venous connection (TAPVC) [1]. The symptoms most commonly associated with APVC are respiratory distress, decreased exercise tolerance, and subsequent circulatory collapse [2], [3]. Surgical treatment offers the only means to prevent progression of the disease; however, high operative mortality rates have been reported, due to the complexity of surgery [4], [5], [6], [7], [8]. Therefore, an appropriate imaging modality is needed to optimize preoperative planning in order to decrease surgical risk.
Cardiac catheterization has long been regarded as the gold standard imaging modality for congenital heart disease [9]. However, it may be not the best chosen because of exist high radiation dose and associated anesthesia-related risks [10]. Furthermore, iatrogenic venous obstruction due to catheter-related injuries cannot be ignored in APVC [11]. Trans-thoracic echocardiography (TTE) is regarded as the diagnostic modality of choice in patients with APVC, but diagnostic accuracy depends largely on the skills and working experience of the operator, as well as the size and quality of the acoustic window [1]. Cardiac magnetic resonance imaging (CMR) may not always be an option due to the lengthy examination time, need for sedation, and expense although the procedure does not involve radiation exposure [12].
Featuring high spatial and temporal resolution, dramatic decrease in radiation dose, excellent image quality, and powerful image post-processing, dual-source computed tomography (DSCT) has been widely used in complex congenital heart disease [11], [13], [14], [15]. To the best of our knowledge, few large-scale studies have focused on DSCT use for APVC [16], [17], [18]. Therefore, we enrolled 123 patients to evaluate the image features and diagnostic agreement of DSCT with TTE for different types of APVC before surgery.
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Study population
From January 2012 to November 2016, 126 patients’ imaging data whose clinical diagnosis was APVC were retrospectively reviewed. The inclusion criterion was confirmed imaging findings of APVC according to ACC/AHC guidelines [19]. TAPVC refers to all pulmonary veins are anomalously connected to the right atrium or to the systemic venous circulation; PAPVC refers to at least one, but not all, pulmonary veins connect to a location other than the left atrium [1]. Patients who were hypersensitivity
Baseline characteristics and associated malformations
PAPVC accounted for a larger proportion of cases (84/123, 68.3%) and had a later intervention age (33.27 ± 23.07 years vs. 7.77 ± 12.22 years, p < 0.01) compared with TAPVC. As for associated malformations, ASD was diagnosed in all TAPVC patients (39/39, 100%), while only 47 ASDs were found in 84 PAPVC patients (47/84, 56.0%). Malformations other than ASD were uncommonly observed in APVC (19/123, 15.4%) (Table 1).
Diagnostic agreement between DSCT and TTE
Among the 75 surgical patients in our study, a total of 187 anomalous veins were detected
Discussion
APVC results from atresia of the pulmonary vein or failure of the pulmonary vein to enter into the left atrium at approximately 3–5 weeks gestation and causes a left-to-right extra-cardiac shunt [25]. Clinical symptoms, natural history, and outcomes depend largely on the number of involved anomalous pulmonary veins, site of the connection, status of the pulmonary venous bed, and combination with ASD or other congenital heart disease [26]. As a result of the greater number of anomalous pulmonary
Conflicts of interest
All authors have no conflict of interests.
Acknowledgements
This work was supported by the Program for New Century Excellent Talents in University (No: NCET-13-0386) and Program for Young Scholars and Innovative Research Team in Sichuan Province (2017TD0005) of China.
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Li Jiang and Lin-jun Xie contributed equally to this work.