Nomograms for Optimal 3D Rotational Angiography in Congenital Cardiac Catheterization
Presenter
Arash Salavitabar, M.D., FSCAI, University of Michigan Congenital Heart Center/C.S. Mott Children’s Hospital, Ann Arbor, MI
Arash Salavitabar, M.D., FSCAI1, Brian A Boe, M.D.2, Darren P. Berman, M.D., FSCAI3, Andrew Harrison, RT(R)(CI)(VI)4, Jason Swinning, RT(R)(CI), RCIS4, Kristy Baptista, BS RT(R)(CI)5 and Aimee K. Armstrong, M.D., FSCAI4, (1)University of Michigan Congenital Heart Center/C.S. Mott Children’s Hospital, Ann Arbor, MI, (2)Joe DiMaggio Children's Hospital, Hollywood, FL, (3)Children's Hospital Los Angeles, Los Angeles, CA, (4)Nationwide Children's Hospital, Columbus, OH, (5)-, Columbus, OH
Keywords: Congenital Heart Disease (CHD) and Imaging & Physiology
Background
Three-dimensional rotational angiography (3DRA) is a valuable imaging modality for congenital cardiac catheterization (CCC). We created 3DRA nomograms for CCC to optimize imaging quality and determined variables associated with quality.
Methods
We performed a single-center retrospective review of 3DRAs using Canon Infinix-I platform with a 5 second injection and post-processed on Vitrea workstation. Reconstructions were graded by 3 interventionalists on a 1-4 scale (High Quality [HQ]: median grade ≥3; Low Quality [LQ]: median grade <3). Univariable analyses were performed, and data are presented as median (range).
Results
From 8/2016-12/2018, 208 3DRAs were performed in 195 CCCs. Median age was 7.2 years (0.04-65.8), weight 23.2 kg (3-147.4). Most 3DRAs (73%) were performed in pulsatile sites. The majority (66%) used dilute contrast, and 78% used ventricular pacing. The nomogram (Figure 1) shows that larger contrast volumes were used in HQ 3DRAs compared to LQ in patients >50 kg (1.3cc/kg [0.5-1.8] vs. 0.8cc/kg [0.4-1.4], p=0.03). HQ 3DRAs of biventricular right hearts were more likely to have used dilute contrast (60% contrast [50-100] vs. 100% contrast [50-100], p=0.03), with a higher total injection volume in patients >50 kg (1.4 cc/kg [1.1-2.1] vs. 1.0 cc/kg [0.9-1.4], p=0.02). One (0.5%) 3DRA-related complication occurred (unstable ventricular tachycardia from rapid pacing).
Conclusions
This is the first study to create contrast dose 3DRA nomograms for CCC. In patients >50kg, greater contrast and total injection volumes were associated with HQ 3DRAs in all patients and right heart biventricular circulations, respectively.
