Clarifying the cardiovascular morphology and associated abnormalities in patients with tricuspid Atresia using multidetector computed tomography angiography

Abstract

The present study sought to assess the intracardiac morphology and associated cardiovascular anomalies in patients with tricuspid atresia using multidetector CT angiography. CT angiography datasets of all patients diagnosed with tricuspid atresia at our institution between November 2014 and December 2021 were retrospectively reviewed. The type of tricuspid atresia and associated cardiovascular structural anomalies detected on CT angiography were evaluated. Tricuspid atresia was identified in 404 patients (276 males [68.3%]; mean age at diagnosis: 4.54 ± 6.61 years [range: 9 months-40 years]). Right isomerism was observed in 12/404 (3%) patients followed by situs inversus in 9/404 (2.2%) and left isomerism in 1/404 (0.2%) patients respectively. All patients (404/404; 100%) had an atrial septal defect and a hypoplastic right ventricle while a ventricular septal defect was seen in 403/404 (99.8%) patients. The most common type based on ventriculo-arterial morphology was Type I, with normally related great vessels (78.5%) followed by Type II, with transposed great arteries (21%) and Type III, with common arterial trunk (0.5%). Pulmonary stenosis and pulmonary atresia were seen in 296/404 (73.26%) and 55/404 (13.6%) patients respectively. A right-sided aortic arch with mirror image branching pattern was seen in 38/404 (9.4%) patients. A patent ductus arteriosus was seen in 100/404 (24.8%) patients. Coronary artery anomalies were observed in 34/404 (8.4%) patients. Tricuspid atresia is a congenital heart defect associated with an array of cardiovascular lesions, most commonly septal defects, conotruncal anomalies and pulmonary outflow tract obstruction. A comprehensive evaluation of cardiovascular morphology using CT angiography may thus prove crucial prior to surgery/interventions in these patients.

Keywords: Cardiovascular anomalies; Intracardiac morphology; Multidetector computed tomography angiography; Tricuspid atresia.