Introduction:
Neonates with Tetralogy of Fallot (TOF) and major aortopulmonary collaterals (MAPCAs) routinely undergo cardiac catheterization in the neonatal period. We have recently incorporated CT angiography into the neonatal evaluation with the hope of eliminating catheterization in those not needing neonatal intervention. We reviewed our experience with CT angiography and its accuracy in determining the need for neonatal intervention.
Methods:
Retrospective review of all patients from April 2005-October 2013 with MAPCAs who had both CTA and cardiac catheterization during the first 120 days of life and within 14 days of one another. The radiologist and interventionalist responsible for reading the studies were blinded to the results of the procedures and each other’s readings. The need for neonatal intervention as predicted by CTA was compared to the ultimate, cath-based decision.
Results:
19 patients (mean age 3.73 days, range 1-9 days of age) were included in the study. In all patients CT was able to predict the need for surgical intervention correctly. CTA was found to be 87% sensitive, 93% specific and 91% sensitive with respect to number of MAPCAs, origin and distribution.
Conclusion:
CT angiography can accurately predict the need for neonatal intervention. In those not requiring neonatal intervention, neonatal cardiac catheterization is not required. CTA may also aid in guiding the subsequent, pre-operative catheterization but cannot replace it. This algorithm eliminates neonatal catheterization in the majority of TOF/MAPCAs patients, and with it the associated risks, and radiation, as well as substantially reducing the cost of the initial hospitalization.
One-stage midline unifocalization and complete repair in infancy versus multiple-stage unifocalization followed by repair for complex heart disease with major aortopulmonary collaterals
