- Email: [email protected]
Cardiac CT in patients with single ventricle physiology
Abstract
http://dx.doi.org/10.1016/j.hlc.2015.06.729 727 Cardiac CT in patients with single ventricle physiology S. Biswas 1,∗ , K. O’Donnell 2 , E. Lui 2 , W. Wilson 1 , F. Langenberg 2 , S. Heinze 2 , N. Better 1 , M. Cheung 3 , L. Grigg 1 , S. Joshi 1 1 Department
of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia 2 Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia 3 Department of Cardiology, Royal Children’s Hospital, Melbourne, VIC, Australia Background: Echocardiography and cardiac MRI are the main imaging modalities used in adult patients with complex congenital heart disease. However, cardiac CT offers complementary imaging and can be performed safely in unwell patients. We sought to review cardiac CT findings in patients with single ventricle physiology. Methods: Records were reviewed of consecutive patients with single ventricle physiology who underwent cardiac CT from February 2012 to February 2015. Results: Eleven patients aged 22 to 36 years (median: 26 years) were identified (7/11 female). Eight patients had undergone Fontan palliation. The indications were hypoxia in 5 patients, haemoptysis in 2 patients, while the remaining 4 underwent CT scanning to delineate extra-cardiac vascular anatomy. Six patients were found to have veno-venous collaterals potentially contributing to hypoxia. One patient had pulmonary emboli while another two patients were found to have in-situ pulmonary vein thrombosis. Potential sources of bleeding were identified in both patients presenting with haemoptysis. Two patients were also found to have coronary arteries running directly behind the sternum that would be at risk of trauma if redo cardiac surgery was undertaken. Overall, CT uncovered four new findings in the five patients who had also undergone cardiac MRI in the preceding year. The median radiation dose delivered was 7.1 milliSieverts. Conclusion: In a significant number of patients in our cohort who had previous echocardiograms or MRI, cardiac CT was able to provide additional information on extracardiac vasculature. Cardiac CT appears to be complementary to established imaging modalities in patients with single ventricle physiology. http://dx.doi.org/10.1016/j.hlc.2015.06.730
S427
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
728 Cardiac pregnancy clinic - a new clinical service at the Royal Melbourne Hospital D. Zentner 1,∗ , E. Posma 2 , L. Balding 1 , L. Grigg 1 1 The
Royal Melbourne Hospital, Melbourne, VIC, Australia 2 The Royal Women’s Hospital, Melbourne, VIC, Australia Aims: To describe patients seen at a multidisciplinary clinic for women with cardiac disease undergoing pregnancy Methodology: Data collection from clinic review entries and discharge summaries Results: Over 18 months, the clinic saw 52 women. Just under half (46%) were pre-existing RMH patients. Unfortunately, 51% of patients attended their first appointment already pregnant, with no opportunity for pre conception counselling. Most women (67%) have congenital heart disease and most (64%) were classed as WHO maternal cardiovascular risk class II – III. Outcomes are known in 37 women: 1 early miscarriage, 1 medically recommended termination and delivery in 35 women. Delivery was vaginal in 20 and by caesarean section in 15. If possible, the original delivery plan made was ascertained and judged against mode of delivery. Where available, data shows that 73% of women with an original plan for a vaginal delivery achieved this and 100% of women deemed to require a CS at initial review delivered in this manner. Maternal cardiac complications included cardiac failure in 6, arrhythmias in 2 and acute worsening of pulmonary hypertension requiring ICU support in 1. Median gestational age was 38 (36-39) weeks (n = 32) and gestational weight 3006 (2570-3475) gms (n = 29). There was 1 fetal death in utero (placental abruption in the setting of endocarditis/sepsis). Conclusions: Cardiology and obstetric staff working together and in close liaison with anaesthetic, nursing and midwifery staff can achieve excellent outcomes in pregnancy in women with complex cardiac disease. http://dx.doi.org/10.1016/j.hlc.2015.06.731 729 Comparative outcomes after acute aortic dissection in genetic aortopathy syndromes D. van der Linde 1 , L. Davies 2 , A. Sherrah 3 , P. Bannon 3 , M. Vallely 3 , M. Wilson 3 , L. Turner 3 , A. Keech 2 , R. Jeremy 1,∗ 1 Sydney
Medical School, University of Sydney, NSW, Australia 2 NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia 3 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Darlinghurst, NSW, Australia Aims: Aortic dissection at a young age is often the first manifestation of a genetic aortopathy, including the lesser
http://dx.doi.org/10.1016/j.hlc.2015.06.729 727 Cardiac CT in patients with single ventricle physiology S. Biswas 1,∗ , K. O’Donnell 2 , E. Lui 2 , W. Wilson 1 , F. Langenberg 2 , S. Heinze 2 , N. Better 1 , M. Cheung 3 , L. Grigg 1 , S. Joshi 1 1 Department
of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia 2 Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia 3 Department of Cardiology, Royal Children’s Hospital, Melbourne, VIC, Australia Background: Echocardiography and cardiac MRI are the main imaging modalities used in adult patients with complex congenital heart disease. However, cardiac CT offers complementary imaging and can be performed safely in unwell patients. We sought to review cardiac CT findings in patients with single ventricle physiology. Methods: Records were reviewed of consecutive patients with single ventricle physiology who underwent cardiac CT from February 2012 to February 2015. Results: Eleven patients aged 22 to 36 years (median: 26 years) were identified (7/11 female). Eight patients had undergone Fontan palliation. The indications were hypoxia in 5 patients, haemoptysis in 2 patients, while the remaining 4 underwent CT scanning to delineate extra-cardiac vascular anatomy. Six patients were found to have veno-venous collaterals potentially contributing to hypoxia. One patient had pulmonary emboli while another two patients were found to have in-situ pulmonary vein thrombosis. Potential sources of bleeding were identified in both patients presenting with haemoptysis. Two patients were also found to have coronary arteries running directly behind the sternum that would be at risk of trauma if redo cardiac surgery was undertaken. Overall, CT uncovered four new findings in the five patients who had also undergone cardiac MRI in the preceding year. The median radiation dose delivered was 7.1 milliSieverts. Conclusion: In a significant number of patients in our cohort who had previous echocardiograms or MRI, cardiac CT was able to provide additional information on extracardiac vasculature. Cardiac CT appears to be complementary to established imaging modalities in patients with single ventricle physiology. http://dx.doi.org/10.1016/j.hlc.2015.06.730
S427
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
728 Cardiac pregnancy clinic - a new clinical service at the Royal Melbourne Hospital D. Zentner 1,∗ , E. Posma 2 , L. Balding 1 , L. Grigg 1 1 The
Royal Melbourne Hospital, Melbourne, VIC, Australia 2 The Royal Women’s Hospital, Melbourne, VIC, Australia Aims: To describe patients seen at a multidisciplinary clinic for women with cardiac disease undergoing pregnancy Methodology: Data collection from clinic review entries and discharge summaries Results: Over 18 months, the clinic saw 52 women. Just under half (46%) were pre-existing RMH patients. Unfortunately, 51% of patients attended their first appointment already pregnant, with no opportunity for pre conception counselling. Most women (67%) have congenital heart disease and most (64%) were classed as WHO maternal cardiovascular risk class II – III. Outcomes are known in 37 women: 1 early miscarriage, 1 medically recommended termination and delivery in 35 women. Delivery was vaginal in 20 and by caesarean section in 15. If possible, the original delivery plan made was ascertained and judged against mode of delivery. Where available, data shows that 73% of women with an original plan for a vaginal delivery achieved this and 100% of women deemed to require a CS at initial review delivered in this manner. Maternal cardiac complications included cardiac failure in 6, arrhythmias in 2 and acute worsening of pulmonary hypertension requiring ICU support in 1. Median gestational age was 38 (36-39) weeks (n = 32) and gestational weight 3006 (2570-3475) gms (n = 29). There was 1 fetal death in utero (placental abruption in the setting of endocarditis/sepsis). Conclusions: Cardiology and obstetric staff working together and in close liaison with anaesthetic, nursing and midwifery staff can achieve excellent outcomes in pregnancy in women with complex cardiac disease. http://dx.doi.org/10.1016/j.hlc.2015.06.731 729 Comparative outcomes after acute aortic dissection in genetic aortopathy syndromes D. van der Linde 1 , L. Davies 2 , A. Sherrah 3 , P. Bannon 3 , M. Vallely 3 , M. Wilson 3 , L. Turner 3 , A. Keech 2 , R. Jeremy 1,∗ 1 Sydney
Medical School, University of Sydney, NSW, Australia 2 NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia 3 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Darlinghurst, NSW, Australia Aims: Aortic dissection at a young age is often the first manifestation of a genetic aortopathy, including the lesser