Dual-source Computed Tomography for Evaluating Pulmonary Artery and Aorta in Pediatric Patients with Single Ventricle

Abstract

To explore the accuracy of main pulmonary artery (MPA) and ascending aorta (AAO) image evaluation in pediatric patients with single ventricle (SV) by comparing dual-source computed tomography (DSCT) with echocardiography. Thirty-one children with SV were retrospectively enrolled. The stenosis, dilation, and location of MPA and AAO were independently evaluated by DSCT and echocardiography. The accompanying arterial malformations were also assessed by DSCT. For 17 patients undergoing cardiac catheterization, the DSCT-based diameters of MPA and AAO were correlated with their pressures as measured by catheterization. Referring to the surgical and catheterization findings, DSCT had better diagnostic performance in detecting the stenosis, dilation, and location of MPA and AAO with higher sensitivity than echocardiography (sensitivity, MPA: 88.0% vs. 80.0%, AAO: 100% vs. 66.7%, great arteries location: 95.7% vs. 95.2%). The correlations between diameters of MPA and AAO with their pressures were 0.399 (p = 0.04) and 0.611 (p = 0.01), respectively. In addition, DSCT detected 23 cases with patent ductus arteriosus, 26 systemic-to-pulmonary collaterals, 9 branch pulmonary distortions, and 4 coronary artery anomalies. DSCT is reliable for assessing the anatomic features of pulmonary artery and aorta in SV children, and provides comprehensive information for surgical strategy-making.

Figure 1

Anatomic types of SV demonstrated by DSCT. Single left ventricle. (a) The ventricle is characterized by relatively smooth walls, fine trabeculations and lack of septal chordal attachments of the atrioventricular valve. Single right ventricle. (b) The ventricle has more coarse trabeculations always accompanied with chordal attachments to the septal surface. Undifferentiated ventricle. (c) The ventricle has the features which are hard to divide into the two types mentioned above. DSCT indicates dual-source computed tomography; SV, single ventricle.

Figure 2

Accompanying arterial malformations detected by DSCT in a 9-year-old female with SV. (a) The transverse plane of univentricle of the patient. (b) The systemic-to-pulmonary collaterals detected by DSCT: The collaterals (arrow) arise between RPA and AO. (c) The PA distortion detected by DSCT: LPA (asterisk) is markedly hypoplastic. AO indicates aorta; DSCT, dual-source computed tomography; LPA, left pulmonary artery; RPA, right pulmonary artery; SV, single ventricle.

Figure 3

Measurements of MPA and AAO in a 9-year-old male with SV. (a) The transverse plane of univentricle of the patient. (b) The measurement of MPA is conducted 1 cm above the pulmonary arterial valve. (c) The measurement of AAO is conducted 1 cm above the aortic sinus. AAO indicates ascending aorta; MPA, main pulmonary artery; SV, single ventricle.