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Cardiovascular Disease I
Title
Cardiovascular Disease I
Editor
iConcept Press
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USD$109.99
ISBN
978-1-922227-54-6
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Chapter -1

Cardiovascular Disease I

PULMONARY CT ANGIOGRAPHY AND CONGENITAL HEART DISEASES

by AMIT NANDAN DHAR DWIVEDI, ISHAN KUMAR and ASIF IQBAL

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Abstract

The human heart is a scaffold of complex and intricate relationships between its different components. Consequently, errors in its embryogenesis, present in many different combinations and their accurate diagnostic characterization requires profound proficiency on part of both cardiologists and radiologists. The variety of presentations of congenital heart disease is so perplexing, that every now and then we encounter a case which defies several classification systems that has been designed to describe these diseases. Congenital heart diseases have been probed by all the existing imaging modalities from plain radiography, angiography, radionuclide imaging to advanced 2D imaging techniques such as echocardiography, CT and MRI and every of these modalities have an important role. Thoracic radiography, often considered banal in modern day practice, may provide the first indication that heart disease is present and if read carefully provide a generalized notion of the type of these lesions rather than a specific diagnosis. Invasive angiography is limited by catheter related complications, overlapping of adjacent cardiovascular structures, inability to assess systemic and pulmonary vasculature simultaneously and relative high dose of radiation dose and iodinated contrast material and reserved mainly for invasive pressure measurement. Echocardiography provides a wealth of both anatomical and dynamic physiological information without significant patient discomfort or risk. It has therefore become a diagnostic ritual for the first hand analysis of patient suspected for congenital heart lesions or any heart disease for that matter. Furthermore echocardiography is being used in many centers intra-operatively to assess immediate post repair global pump function and provide immediate evaluation of results. However, transthoracic Echocardiography is limited by certain blind spots such as ascending aorta and the arch of aorta, the distal pulmonary arteries, the right ventricle and the pulmonary veins. Still, in modern day practice echocardiography is most well suited for initial assessment and it would not be an overstatement to say that most of the evaluation start with echo and end with echo. If it needs to go further, the choice of investigation lies between CT and MRI. Although MRI is extremely meticulous in detailing the anatomical and functional character of the heart, it is time consuming and coerce the need to sedate and intubate the patients especially in pediatric age group. CT on the other hand is extremely fast and has widespread availability but exposes patients to significant radiation burden. A trade-off between advantages and disadvantages between these two modalities must be made and a diagnostic protocol must be individualized from patient to patient basis. Modern CT workstations are equipped with multiplanar reformation techniques which is necessary for accurate assessment of various vessels because vessels through their course change their axis and can be optimally evaluated in different plane. The analysis of congenital heart lesions is best achieved by systematic segmental approach which divides heart into three main segments i.e. atria, ventricles and the great vessels and the connections between these chambers i.e. artrioventricular and ventriculoatrial connections. Careful step by step evaluation of visceroatrial situs, cardiac chambers, their connections and associated malformations should be done to complete the CT study. It is our endeavor to describe the role of CT pulmonary angiography and features of various congenital heart diseases which will help the radiologists to interpret these complex anomalies.

Author Details

AMIT NANDAN DHAR DWIVEDI
DEPARTMENT OF RADIODIAGNOSIS AND IMAGING.BANARAS HINDU UNIVERSITY, India
ISHAN KUMAR
DEPARTMENT OF RADIODIAGNOSIS AND IMAGING.BANARAS HINDU UNIVERSITY, India
ASIF IQBAL
DEPARTMENT OF GENERAL MEDICINE.BANARAS HINDU UNIVERSITY

Citation

AMIT NANDAN DHAR DWIVEDI, ISHAN KUMAR and ASIF IQBAL. PULMONARY CT ANGIOGRAPHY AND CONGENITAL HEART DISEASES. In Cardiovascular Disease I. ISBN:978-1-922227-54-6. iConcept Press. 2014.

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