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. 2015 Nov;114(11):1061-8.
doi: 10.1016/j.jfma.2014.08.004. Epub 2014 Sep 18.

Trends in the utilization of computed tomography and cardiac catheterization among children with congenital heart disease

Justin Cheng-Ta Yang  1 , Ming-Tai Lin  2 , Fu-Shan Jaw  3 , Shyh-Jye Chen  4 , Jou-Kou Wang  2 , Tiffany Ting-Fang Shih  5 , Mei-Hwan Wu  2 , Yiu-Wah Li  5
Affiliations

Trends in the utilization of computed tomography and cardiac catheterization among children with congenital heart disease

Justin Cheng-Ta Yang et al. J Formos Med Assoc. 2015 Nov.

Abstract

Background/purpose: Pediatric cardiac computed tomography (CT) is a noninvasive imaging modality used to clearly demonstrate the anatomical detail of congenital heart diseases. We investigated the impact of cardiac CT on the utilization of cardiac catheterization among children with congenital heart disease.

Methods: The study sample consisted of 2648 cardiac CT and 3814 cardiac catheterization from 1999 to 2009 for congenital heart diseases. Diagnoses were categorized into 11 disease groups. The numbers of examination, according to the different modalities, were compared using temporal trend analyses. The estimated effective radiation doses (mSv) of CT and catheterization were calculated and compared.

Results: The number of CT scans and interventional catheterizations had a slight annual increase of 1.2% and 2.7%, respectively, whereas that of diagnostic catheterization decreased by 6.2% per year. Disease groups fell into two categories according to utilization trend differences between CT and diagnostic catheterization. The increased use of CT reduces the need for diagnostic catheterization in patients with atrioventricular connection disorder, coronary arterial disorder, great vessel disorder, septal disorder, tetralogy of Fallot, and ventriculoarterial connection disorder. Clinicians choose either catheterization or CT, or both examinations, depending on clinical conditions, in patients with semilunar valvular disorder, heterotaxy, myocardial disorder, pericardial disorder, and pulmonary vein disorder. The radiation dose of CT was lower than that of diagnostic cardiac catheterization in all age groups.

Conclusion: The use of noninvasive CT in children with selected heart conditions might reduce the use of diagnostic cardiac catheterization. This may release time and facilities within the catheterization laboratory to meet the increasing demand for cardiac interventions.

Keywords: cardiac catheterization; children; congenital heart disease; multidetector computed tomography; utilization.

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Figures

Figure 1
Figure 1
Number of CT performed per year. (A) Total number of CT and interventional and diagnostic catheterization (cath-I and cath-D) in each year. Note the decline in 2003 (arrow) due to SARS in our country. Broken lines indicate trend linear regression. CT and interventional catheterization had a slight annual increase of 1.2% and 2.7%, respectively. Diagnostic catheterization had an annual decrease of 6.2%. (B) There are significant trend differences between the number per year of CT and diagnostic catheterization in VA connection disorder, septal disorder, tetralogy of Fallot, coronary arterial disorder, AV connection disorder, and great vessel disorder. (C) There are no significant trend differences between the number per year of CT and diagnostic catheterization in heterotaxy, myocardial disorder, pericardial disorder, pulmonary venous disorder and semilunar valvular disorder. AV = atrioventricular; cath-D = diagnostic catheterization; cath-I = interventional catheterization; CT = computed tomography; SARS = severe acute respiratory syndrome; VA = ventriculoarterial.
Figure 2
Figure 2
Mean effective doses in each age group of cardiac computed tomography (CT) (blue) and catheterization (red) in the study institute.
See this image and copyright information in PMC

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