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Pre-procedural CT imaging aids neonatal PDA stenting for ductal-dependent pulmonary blood flow with reduction in overall procedural morbidity

Part of: Advanced Imaging

Published online by Cambridge University Press:  19 October 2021

Yousef Arar Open the ORCID record for Yousef Arar [Opens in a new window] ,
V. Vivian Dimas ,
Alan W. Nugent ,
Tarique Hussain ,
Nima Kasraie ,
Surendranath R. Veeram Reddy Open the ORCID record for Surendranath R. Veeram Reddy [Opens in a new window] ,
Thomas M. Zellers  and
Carrie Herbert
Yousef Arar*
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
V. Vivian Dimas
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
Alan W. Nugent
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
Tarique Hussain
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
Nima Kasraie
Affiliation:
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Surendranath R. Veeram Reddy
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
Thomas M. Zellers
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
Carrie Herbert
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatric Cardiology, Children’s Medical Center, Dallas, Texas, USA
*
Author for correspondence: Y. Arar, Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235-7701, USA. Tel: +214 456 7311; Fax: +214 456 6154. E-mail: [email protected]
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Abstract

Patent ductus arteriosus stenting for ductal-dependent pulmonary blood flow is a technically challenging neonatal procedure to maintain a stable pulmonary circulation. Pre-procedural computed tomography imaging aids in outlining ductal origin, insertion, size, course and curvature. Computed tomography imaging may add value to procedural outcomes and reduce overall procedural morbidity in neonatal patent ductus arteriosus stenting. We conducted a single centre retrospective chart review of neonates with ductal-dependent pulmonary blood flow who underwent patent ductus arteriosus stenting between January 1, 2014 and June 31, 2020. We compared patients variables between patients who underwent pre-procedural computed tomography imaging to those who did not. A total of 64 patients were referred for patent ductus arteriosus stenting with 33 (52%) obtaining pre-procedural computed tomography imaging. Average age [19 days; range 1–242 days (p = 0.85)] and weight [3.3 kg (range 2.2–6.0 kg; p = 0.19)] was not significantly different between the groups. A diagnosis of pulmonary atresia was made in 42 out of 64 (66%) patients prior to patent ductus arteriosus stenting. The cohort with pre-intervention computed tomography imaging had a significant reduction in the total number of access sites (1.2 versus 1.5; p = 0.03), contrast needed (5.9 versus 8.2 ml/kg; p = 0.008), fluoroscopy (20.7 versus 38.8 minutes; p = 0.02) and procedural time (83.4–128.4 minutes; p = 0.002) for the intervention. There was no significant difference in radiation burden between the groups (p = 0.35). Pre-procedural computed tomography imaging adds value by aiding interventional planning for neonatal patent ductus arteriosus stenting. A statistically significant reduction in the number of access sites, contrast exposure, as well as fluoroscopic and procedural time was noted without significantly increasing the cumulative radiation burden.

Keywords

Congenital heart Diseasepaediatric catheterisation/interventionadvanced imagingcardiac CT
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 9 , September 2022 , pp. 1401 - 1406
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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