Evaluation of image quality and radiation dose of thoracic and coronary dual-source CT in 110 infants with congenital heart disease

Background:  There are only a few reports on the diagnostic accuracy, and the technical and clinical feasibility, of multidetector CT (MDCT) in infants with congenital heart disease (CHD). Objective:  To evaluate the image quality and radiation dose of DSCT in babies with CHD. Materials and methods:  From November 2006 to November 2007, 110 consecutive infants with CHD referred for pre- or postoperative CT evaluation were included. All these infants had a spiral angiothoracic DSCT scan after injection of 300 mg/ml iopromide at 0.5–1 ml/s with a power injector using a low-dose protocol (80 kVp and 10 mAs/kg). Of these infants, 34 also underwent an ECG-gated coronary CT scan for evaluation of the course of the coronary arteries. Results:  No serious adverse events were recorded. The mean dose-length product was 8±6 mGy.cm (effective dose 0.5±0.2 mSv) and 21±9 mGy.cm (effective dose 1.3±0.6 mSv) during the non-ECG-gated spiral acquisition and ECG-gated acquisition, respectively. Diagnostic quality images were achieved with the spiral acquisition in 89% of cases. Compared to the spiral mode, ECG-gated acquisition significantly improved the visualization of the coronary arteries, with a diagnostic rate of 91% and 84% for the left and right coronary arteries, respectively. Conclusion:  DSCT together with iopromide at 300 mg/ml is a valuable tool for the routine clinical evaluation of infants with CHD. ECG-gated acquisition provides reliable visualization of the course of the coronary arteries.     

Radiation dose for thoracic and coronary step-and-shoot CT using a 128-slice dual-source machine in infants and small children with congenital heart disease

Background  

For coronary artery visualization, retrospective ECG-gated acquisition by dual-source computed tomography (DSCT) was superior to spiral non-ECG-gated acquisition in a paediatric population of congenital heart disease (CHD) patients. However, retrospective cardiac CT is associated with substantial radiation doses to the patient. Recently, DSCT with end-systolic reconstruction was found to be robust for imaging the coronary arteries in patients with high heart rates.     

Coronary artery visibility in free-breathing young children with congenital heart disease on cardiac 64-slice CT: dual-source ECG-triggered sequential scan vs. single-source non-ECG-synchronized spiral scan

Background  

The potential impact of dual-source ECG-triggered sequential CT scan on coronary artery visibility has not been evaluated in free-breathing young children.     

Birthweight of infants with congenital heart disease

A subnormal birth weight distribution was noted in a population of infants seen during the first year of life for major congenital heart disease (CHD). When arranged according to cardiac diagnostic categories, 17 of the 21 major cardiac lesions were associated with subnormal birth weight distribution. Major extracardiac anomalies present in 19.9% of all infants appeared not to influence the birth weight distributions of either the total population of 19 of 21 cardiac lesion categories. An increased incidence (6.1%) of small-for-dates infants was observed in the study population. Extra-cardiac anomalies occurred in 28% of the small-for-dates infants. Survival to 1 year of age was 42.8% for the total population with CHD and 49.2% in the small-for-dates group.     

Developmental delay in infants with congenital heart disease

Summary The mental and motor development of 173 infants with congenital heart disease was assessed by means of the Bayley Scales of Infant Development and clinical neurological examinations. The relationship between age, sex, congestive heart failure, hypoxemia, hospitalization, and test results was evaluated. The presence of congestive heart failure was found to be significantly associated with both mental and motor developmental delay. Hypoxemia and hospitalization were associated with delayed motor development. Developmental delay could be recognized as early as 2 months of age. Supported in part by training grant HL 05855 and program project grant HL 10436 from the National Institutes of Health, Bethesda, Maryland     

Myocardial calcifications in infants with congenital heart disease

Summary A histopathologic study of six hearts from infants with congenital heart disease and myocardial calcification revealed that foci of calcification were surrounded by normal-appearing myocardial tissue, ischemic myocardial tissue, or both. Inflammatory process, necrotic tissue removal process, and scar formation were not identified in the majority of these subjects. Three congenital heart anomalies are newly reported as associated with myocardial calcifications. The results of this study give evidence that necrotic tissue in the myocardium of some infants tends to become calcified rather than be removed and scarred as occurs in the adult. It also confirms that prenatal cardiac disease and trauma such as surgery might account for the presence of myocardial calcification.     

Outcome of preterm infants with congenital heart disease

OBJECTIVES AND STUDY DESIGN: To evaluate the morbidity and mortality of preterm infants with congenital heart disease (CHD), a chart review was performed for infants with CHD, excluding isolated patent ductus arteriosus, who were <37 weeks' gestation, weighed <2500 g, and were admitted to our neonatal intensive care unit from 1976 to 1999 (N = 201). RESULTS: Patients in the study represented 1.9% of the total neonatal intensive care unit population <37 weeks' gestation and <2500 g. The median gestational age was 33 weeks, and the mean birth weight was 1852 g. CHD diagnosis frequencies were similar to those reported in other large incidence studies, except for a higher percentage of conotruncal defects. The risk of necrotizing enterocolitis was 1.7 times higher and the overall mortality twice as high in our patients compared with patients in the neonatal intensive care unit who did not have CHD. Cardiac surgery (n = 133) was performed on 108 patients. During the recent period of 1985 to 1999, compared with our institution's overall results for CHD surgery, the operative mortality rate was 10.4% versus 5.4% for closed procedures and 25.4% versus 10.5% for open procedures. The actuarial survival rate is 51% at 10 years; survival improved as the study period progressed. CONCLUSIONS: Infants with both CHD and prematurity did significantly worse than either group alone. Such outcome data are required for proper allocation of resources to care for this high-risk pediatric population.     

围术期处理在婴幼儿先天性心脏病中的临床意义

目的 总结婴幼儿先天性心脏病的围术期处理体会。方法 手术治疗先心病患儿83例,年龄1 d～3岁,其中单纯畸形55例,复杂畸形28例。除动脉导管未闭(PDA)外,均在体外循环下行心内直视手术矫治。2例动脉导管未闭合并主动脉缩窄者行分期手术,合并其它畸形者均予以同期矫治。结果 全组住院死亡6例(7.2%),并发症发生率12%,余77例随访1年无并发症及死亡。结论 婴幼儿先天性心脏病治疗过程中必须加强围术期处理。     

Extracardiac abnormalities in infants with congenital heart disease.

Extracardiac anomalies (ECA) occur in 25% of infants seen during the first year of life for significant cardiac disease. Often the ECA are multiple and one third of the affected infants have some established syndrome. In infants with endocardial cushion defect, patent ductus arteriosus, atrial septal defect, ventricular septal defect, malpositions, tetralogy of Fallot, and complex coarctation ECA occur in 25% or more of the cases. The most frequent ECA are in the musculoskeletal system or associated with a specific syndrome. The presence of an ECA significantly increases the mortality in infants with CHD.     

Intestinal function in infants with severe congenital heart disease

We evaluated digestive tract function in 21 young infants with severe congenital heart disease. One group had congestive heart failure and ventricular septal defect or single ventricle; the other had cyanosis and transposition of the great arteries. Enteric protein loss was excessive in eight patients, and steatorrhea was found in five. These abnormalities were mild and not related to the type or severity of the cardiac lesion. Available evidence points to a need of these babies for calories in excess of normal requirements for weight. The present study suggests that in designing dietary regimens for these very sick patients, their potential for defective gastrointestinal function must be considered. Because no consistent pattern of abnormalities in apparent, each patient who fails to thrive may deserve gastroenterologic evaluation.     

Delayed sternal ossification in infants with congenital heart disease

A review of the lateral chest radiographs of 118 children less than two years old and suspected of having congenital heart disease yielded 11 who had delayed ossification of the mesosternum. In all 11 congenital heart disease was confirmed by cardiac catheterization, with the most frequent lesions being patent ductus arteriosus, ventricular septal defect, and atrial septal defect. A review of the lateral chest radiographs of 110 normal infants failed to demonstrate any case of delayed ossification of the sternum. If sternal segments do not appear ossified on chest radiographs of infants having no other clinical abnormalities, congenital heart disease should be suspected.     

Prevalence of T-lymphocyte abnormalities in infants with congenital heart disease

Thirty-two infants younger than 6 months with catheterization-proved congenital heart disease were prospectively examined for T-lymphocyte immunodeficiency (compared with adult and normal newborn controls). Cardiac lesions were separated into two groups: (1) "high-risk" lesions previously associated with T-cell abnormalities in DiGeorge's syndrome, and (2) the remaining "low-risk" lesions. Cardiac patients as a whole did not have significant abnormalities in T-cell rosette (TCR) percentages (mean +/- SE, 50.0% +/- 22%) or response to phytohemagglutinin (PHA) (72,243 +/- 38,388 counts per minute). However, a greater percentage of patients with high-risk cardiac lesions had abnormal TCR and PHA results than either the control or low-risk group, due to the inclusion of three infants with DiGeorge's syndrome. These findings suggest that newborn infants without evidence of DiGeorge's syndrome have normal T-lymphocyte function. Infants with high-risk cardiac lesions deserve a careful immunologic evaluation to avoid significant morbidity and mortality.     

Growth and nutritional intake of infants with congenital heart disease

Summary Poor weight and length gain of infants with congenital heart disease is generally considered to be related to inadequate nutritional intake, but no longitudinal data on growth and nutritional intake of such infants are available. We compared weight, length, subscapular and triceps skinfold thickness, energy and protein intake (24-h dietary intake records) as well as serum prealbumin and albumin of infants with cyanotic heart disease (n=8) or isolated left-to-right shunt (n=8) with those of healthy infants aged (n=8) 45–365 days. Weight, length, and combined (subscapular and triceps) skinfold thickness of the two groups with congenital heart disease (CHD) were significantly less from 183 through 365 days of age. However, energy and protein intake was similar to that of the control group from 45 through 365 days of age. Normal serum prealbumin and albumin in the infants with CHD ruled out protein-calorie malnutrition. It is concluded that a low level of food intake was not the main cause of inadequate growth and of small subcutaneous fat stores in these two small, but homogeneous, groups of infants with CHD.     

Retinopathy of prematurity in infants with cyanotic congenital heart disease

We undertook a study of premature infants with cyanotic congenital heart disease to determine whether these infants develop retinopathy of prematurity despite a persistent hypoxemic state. Using the computerized registry of the neonatal intensive care unit of Vanderbilt University Medical Center, Nashville, Tenn, we identified six premature infants (less than 37 weeks' gestational age, with birth weights of 1100 to 2050 g) with cyanotic congenital heart disease who survived the neonatal period and underwent ophthalmologic evaluation. Review of their charts revealed that three of six infants developed retinopathy of prematurity (two had grade 1 and one had grade 3 disease), but none required treatment. Our data support the findings of other investigators that elevated arterial oxygen tension is not the sole factor leading to the development of retinopathy of prematurity. Premature infants with cyanotic congenital heart disease can develop retinopathy of prematurity despite persistent hypoxemia. Cyanotic premature infants should be screened for retinopathy of prematurity with the same thoroughness as other premature infants.