CT for assessment of thrombosis and pulmonary embolism in multiple stages of single-ventricle palliation: Challenges and suggested protocols

Maryam Ghadimi Mahani*, Prachi P. Agarwal, Cynthia K. Rigsby, Jimmy C. Lu, Soudabeh Fazeli Dehkordy, Robyn A. Wright, Adam L. Dorfman, Rajesh Krishnamurthy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

The total cavopulmonary connection (TCPC), or Fontan procedure, diverts systemic venous blood directly into the pulmonary arteries and is the palliative surgery of choice for patients with a wide variety of congenital heart diseases with single-ventricle physiologic characteristics. Pulmonary embolism and thrombosis are known complications and are among the major causes of morbidity and mortality in patients after TCPC. Magnetic resonance (MR) imaging is usually performed for postoperative evaluation of patients after single-ventricle repair; however, screening for thrombosis or embolism with MR imaging is not always feasible because of the emergent nature of the clinical presentation or because of artifacts from metallic devices or coils. Computed tomographic (CT) angiography is an effective method for diagnosing pulmonary embolism in children. However, because of altered hemodynamics after single-ventricle palliation, there are unique challenges in achieving optimal opacification of the pulmonary arteries and Fontan circuit that can result in nondiagnostic CT angiographic studies or erroneous image interpretation. Radiologists should be familiar with the multiple stages of single-ventricle palliation, understand the technique for performing pulmonary CT angiography at each stage, and recognize common pitfalls in obtaining and interpreting pulmonary CT angiographic images in patients who have undergone single-ventricle repair.

Original languageEnglish (US)
Pages (from-to)1273-1284
Number of pages12
JournalRadiographics
Volume36
Issue number5
DOIs
StatePublished - Sep 1 2016

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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