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首页> 外文期刊>The Egyptian Journal of Hospital Medicine >Congenital Extra-Cardiac Vascular Anomalies as Detected on Multislice Computed Tomography Angiography
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Congenital Extra-Cardiac Vascular Anomalies as Detected on Multislice Computed Tomography Angiography

机译：在多层计算机断层扫描血管造影上检测到的先天性心脏外血管异常

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Background: Accurate evaluation of extra cardiac and intra cardiac anomalies in congenital heart diseases (CHD) is vital for diagnosis and treatment. Trans-thoracic echocardiography (TTE) is the classical choice for children suspected to have CHD because TTE is safe, readily available and its capacity to perform Doppler flow studies therefore can measure hemodynamic parameters. Plus its ability to evaluate intra cardiac abnormalities like atrial septal defect and ventricular septal defect. Therefore, owing to its lower spatial resolution and limited acoustic window; it is not precise in evaluation of extra cardiac abnormalities. Aim of the Work: to evaluate the advantage of recent advances of ECG gated MDCT in diagnosis of congenital heart disease in pediatrics and assessment of associated extra cardiac abnormalities within the great vessels in comparison with echocardiography findings. Patients and Methods: The current study was carried out on 36 patients in Radio-diagnosis Department, Faculty of medicine, Ain Shams University and specialized private radiology centers. The patients were referred from pediatric hospital, cardiology clinic with their echocardiographic reports to radio-diagnosis department, cardiac imaging unit with a view to execute ECG- gated multi-slice CT of the heart & extra-cardiac great vessels. Results: In this study aortic anomalies represent the most common extra-cardiac anomalies accounting for 36.5% of our cases while comprising: Supravalvular aortic stenosis; 4.3%, Aortic CoA; 26.1%, arch anomalies with vascular rings; 52.2% and finally anomalous coronary arteries; 17.4%. By Using MDCT we were able to delineate eight cases of right aortic arch (RAA).Two of them with aberrant left subclavian artery (ALSCA) adding to two cases of left aortic arch with an aberrant right subclavian artery (ARSCA). On the other hand ,TTE failed to identify 6 cases of RAA with a sensitivity 75%, specificity 100%, NPV 96.61% and one case of ALSCA with a sensitivity 50.0%, specificity 100%, NPV 98.41% .Regarding coronary anomalies , Cardiac CTA succeeded in characterization of origin and course of all coronary abnormalities encountered in our study encompassing 4 cases specifically anomalous LAD from right coronary sinus running a prepulmonic course anterior to RVOT , RCA from LAD and single coronary artery adding to LCX- RV coronary fistula. While TTE failed to depict two cases of the coronary anomalies with a sensitivity of 50%, specificity 100%, PPV 100% and NPV 96.83%. Conclusion: CTA can provide the confident detection and exclusion of extra- cardiac vascular abnormalities with superb anatomical description which was feasible with a sensitivity 98.41%, specificity 99.76%, PPV 96.88% and NPV 99.88%.
机译：背景：先天性心脏病（CHD）中心脏和心脏内异常的准确评估对于诊断和治疗至关重要。经胸超声心动图（TTE）是怀疑患有CHD的儿童的经典选择，因为TTE安全，容易获得，并且其进行多普勒血流研究的能力可以测量血液动力学参数。加上其评估心脏内异常（如房间隔缺损和室间隔缺损）的能力。因此，由于其较低的空间分辨率和有限的声学窗口;在评估额外的心脏异常方面并不精确。工作的目的：与超声心动图检查结果相比，评估心电门控MDCT在儿科先天性心脏病诊断中的最新进展以及评估大血管内相关的额外心脏异常的优势。患者和方法：本研究在爱因沙姆斯大学医学院放射诊断科和专门的放射学中心对36名患者进行。患者将其超声心动图报告从儿科医院，心脏病诊所转诊给放射诊断部门，心脏成像单元，以执行心脏和心脏大血管的ECG门控多层CT检查。结果：在这项研究中，主动脉异常代表最常见的心脏外异常，占我们病例的36.5％，同时包括：瓣膜上主动脉瓣狭窄; 4.3％，主动脉CoA; 26.1％，具有血管环的弓形异常; 52.2％，最终冠状动脉异常; 17.4％。通过使用MDCT，我们能够描绘出8例右主动脉弓（RAA），其中2例左锁骨下动脉异常（ALSCA）加上2例左主动脉弓的右锁骨下动脉异常（ARSCA）。另一方面，TTE未能识别出6例RAA，其敏感性为75％，特异性为100％，NPV为96.61％，而1例ALSCA的敏感性为50.0％，特异性为100％，NPV为98.41％。 CTA成功地表征了我们研究中遇到的所有冠状动脉异常的起源和病程，包括4例来自右冠状窦的异常LAD，在RVOT之前进行了肺动脉前的病程，从LAD进行的RCA和单冠状动脉加了LCX-RV冠状动脉瘘。尽管TTE未能以敏感性50％，特异性100％，PPV 100％和NPV 96.83％描绘2例冠状动脉异常。结论：CTA可以提供可靠的检测和排除心脏外血管异常，具有出色的解剖学描述，可行，灵敏度为98.41％，特异性为99.76％，PPV为96.88％，NPV为99.88％。

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