Multi-institution assessment of the use and risk of cardiovascular computed tomography in pediatric patients with congenital heart disease |
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| Institution: | 1. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA;2. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA;3. Medical University of South Carolina, Charleston, SC, USA;4. Royal Brompton Hospital, London, UK;5. Children’s Minnesota, Minneapolis, MN, USA;1. Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedale-Università, University of Padua, Padua, Italy;2. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK;1. Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA;2. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands;3. Department of Healthcare Policy and Research, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, USA;4. Centro Cardiologico Monzino, IRCCS Milan, Italy;5. Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA;6. Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy;7. Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA;8. Pusan University Hospital, Busan, South Korea;9. UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal;10. Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil;11. Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany;12. Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada;13. Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy;14. Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea;15. Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea;p. Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea;q. Seoul National University Bundang Hospital, Sungnam, South Korea;r. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea;s. Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea;t. Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA;u. Department of Pathology, CVPath Institute, Gaithersburg, MD, USA;v. Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA;w. Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;x. Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA;1. Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA;2. Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA;3. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA;4. Université Laval, Quebec City, Quebec, Canada;5. New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA;1. GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy;2. IRCCS San Raffaele Scientific Institute, Italy;3. Vita-Salute San Raffaele University, Italy;4. Guglielmo da Saliceto Hospital, Piacenza, Italy;5. Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy;6. Ospedale di Cremona, Cremona, Italy;7. Centro Cardiologico Monzino IRCCS, Milano, Italy;8. Ospedale Maggiore, Bologna, Italy;9. San Gerardo Hospital, Monza, Italy;10. ASST Bolognini Hospital, Bergamo Est, Italy;11. Parma University Hospital, Parma, Italy;12. ASST Valtellina and Alto Lario, “Eugenio Morelli Hospital”, Sondalo, Italy;13. San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy;14. Casa di Cura Villa dei Pini, Civitanova Marche, Italy;15. ICC Istituto Clinico Casalpalocco, Rome, Italy;p. San L. Mandic Hospital, Merate, Italy;q. ASST Papa Giovanni XXIII, Bergamo, Italy |
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| Abstract: | BackgroundCardiac computed tomography (CT) is increasingly used in pediatric patients with congenital heart disease (CHD). Variability of practice and of comprehensive diagnostic risk across institutions is not known.MethodsFour centers prospectively enrolled consecutive pediatric CHD patients <18 years of age undergoing cardiac CT from January 6, 2017 to 1/30/2020. Patient characteristics, cardiac CT data and comprehensive diagnostic risk were compared by age and institutions. Risk categories included sedation and anesthesia use, vascular access, contrast exposure, cardiovascular medication, adverse events (AEs), and estimated radiation dose.ResultsCardiac CT was performed in 1045 pediatric patients at a median (interquartile range, IQR) age of 1.7 years (0.3, 11.0). The most common indications were arterial abnormalities, suspected coronary artery anomalies, functionally single ventricle heart disease, and tetralogy of Fallot/pulmonary atresia. Sedation was used in 8% and anesthesia in 11% of patients. Peripheral vascular access was utilized for 93%. Median contrast volume was 2 ml/kg. Beta blockers were administered in 11% of cases and nitroglycerin in 2% of cases. The median (IQR) total procedural dose length product (DLP) was 20 mGy1cm (10, 50). Sedation, vascular access, contrast exposure, use of cardiovascular medications and radiation dose estimates varied significantly by institution and age (p < 0.001). Seven minor adverse events (0.7%) and no major adverse events were reported.ConclusionCardiac CT for CHD is safe in pediatric patients when appropriate CT technology and expertise are available. Scans can be acquired at relatively low radiation exposure with few minor adverse events. |
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| Keywords: | Cardiac computed tomography Pediatric Congenital heart disease Dose length product Comprehensive diagnostic risk |
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